Chapter 14: Distributive Justice

material principle of justice

...the rationale for determining those times when there can be unequal allocation of scarce resources.

rights, need, and merit

3 perspectives on the way to address ethical dilemmas of justice

merit justice

Spending money of those individuals that are a "good investment" rather than based on relative medical need (i.e. based on a person's societal contributions, wealth, and fame)

data banks and registries

used to collect, analyze and disseminate mass amounts of data of many like-situated patients to advance clinical care outcomes for all members of the group

procedural justice

if you get there first, you have constituted a moral claim on the spot; top priority remains in place

allocation of healthcare resources

intentional decisions about how a healthcare good or service is distributed

microallocation

justice-related decisions that involve trade-offs among goods and services within one value arena, such as healthcare

macroallocation

justice-related decisions that involve trade-offs among valued societal goods and services that are made by larger bodies such as congress and health organizations

healthcare as a right

no one can be dismissed of healthcare on the basic level of ethical critique, but it does not differentiate what kind of healthcare each individual or group is entitled to receive

very important person (VIP)

people who receive special treatment and jump to the head of the line for precious resources; public figures with high social status (government officials, stars, CEOs, athletes)

principle of equity

policy decision makers must make every effort to set guidelines that treat each person in a similarly situated circumstance alike, with differences among them based on criteria that are ethnically acceptable

"first come, first served"

principle for determining who gets priority attention in a queue; patient is not removed for other similarly situated persons who come along afterwards

parsimonious decisions

recognition of the wisdom of realizing the overall value of honoring limits that do not hold professionals hostage to the traditional professional ethic in which an identified patient's right or need becomes the sole criterion for decisions in the healthcare arena

formal principle of justice

similarly situated persons must be treated similarly; conceptual basis from which the notions of fairness and equity are derived

positive rights

supports policies that make everyone eligible to receive basic healthcare benefits; at minimum, access has to be universally available at the level of basic services, either free of charge or provided for at a very modest price

negative right

the right to an opportunity to purchase a good or service; everyone buys what they need and want and can afford

healthcare as a right, healthcare as a response to a basic need, and healthcare as a commodity

three material principles of justice

cost, quality, and access

triad of healthcare policy

entitlement

a person deserves the good or service simply by being a member of a group with a basic claim on a share of a prized good or service

financial stewardship

advances the idea that clinicians ought to play a more direct role in controlling healthcare costs

healthcare as a commodity

advocate that healthcare should be viewed ethically as any other type of product in free market society

distributive justice

assumes that humans have the capacity to make nonarbitrary, reasonable bases for allocating goods and services that are in at least moderately scarce supply but desired by many

principle of fairness

characterized by equity, respect, justice and stewardship of the shared world, both among people and in their relations to other living beings.

healthcare as a response to basic need

clinical need is a sound criterion on which to base allocation

accountable care organizations

function on a fee-for-service basis with modest incentives to contain costs while demonstrating high-quality care [with the base purpose of giving access to many people currently without the means to buy health insurance]