This paper compares and contrasts three different substantive (as opposed to procedural) principles of justice for making health care priority-setting or “rationing” decisions: need principles, maximising principles and egalitarian principles. The principles are compared by tracing out their implications for a hypothetical rationing decision involving four identified patients. This decision has been the subject of an empirical study of public opinion based on small-group discussions, which found that the public seem to support a pluralistic combination of all three kinds of rationing principle. In conclusion, it is suggested that there is room for further work by philosophers and others on the development of a coherent and pluralistic theory of health care rationing which accords with public opinions.
- Health care
- medical ethics
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Richard Cookson is Senior Lecturer, the Health Economics Group, School of Health Policy and Practice, University of East Anglia. Paul Dolan is Reader in Health Economics, School of Health and Related Research and Department of Economics, University of Sheffield.
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