J Butler. Cassell, 1999, £16.99, pp 248. ISBN 0304705829

This book is about scarcity and rationing in health care and the ethical questions they raise. It is based on the premise that if the aim of a responsible government is to balance the nation's varied claims upon the collective purse, then no government can be morally blamed for failing to remove the need of rationing from the National Health Service (NHS), and thus rationing as such cannot give rise to legitimate moral concerns. The question that needs to be addressed therefore is not whether rationing itself is unethical, or even whether any particular distribution mechanisms are unethical, but whether they are structured and work in morally acceptable ways, and lead to morally acceptable results.

In the first chapter Butler describes the gap between needs and resources. He describes what has been done (mainly) in the UK as a way of providing the background to the rationing debate. The second chapter addresses the moral …