Drawing the Line: Healthcare Rationing and the Cutoff Problem
Philip M. Rosoff
Abstract
Rationing of healthcare is an accepted reality in every developed country; how it is accomplished—if it is fair, equitable, and just—is the key to whether it meets the moral norm of distributive justice and if it can be acceptable to those whom it affects. One of the major challenges facing those who would design a comprehensive rationing system for the allocation of healthcare resources is the cutoff problem. This is the dilemma that affects almost all sorts of rationing decisions: where to draw the cutoff points between what is reasonable to provide (and to whom) and what is unreasonable. In ... More
Rationing of healthcare is an accepted reality in every developed country; how it is accomplished—if it is fair, equitable, and just—is the key to whether it meets the moral norm of distributive justice and if it can be acceptable to those whom it affects. One of the major challenges facing those who would design a comprehensive rationing system for the allocation of healthcare resources is the cutoff problem. This is the dilemma that affects almost all sorts of rationing decisions: where to draw the cutoff points between what is reasonable to provide (and to whom) and what is unreasonable. In this book, a comprehensive argument is presented that discards other proposed determinants, such as age, as morally unjust and elucidates a theory that is based on a detailed understanding of medical need. The argument also understands that rationing of this sort only makes sense and can be justified when it is incorporated in a universal, comprehensive healthcare provision scheme. The book also considers arguments against this proposal as well as potential challenges based on serious issues such as the inherent uncertainty of medicine, the role of probability in prognostication, and patient demands for healthcare based on what are called “illegitimate” requests. In the end, the author makes a layered moral argument not only for the necessity of rationing, but its essential fairness if done well.
Keywords:
healthcare rationing,
healthcare needs,
distributive justice,
cutoff problem,
universal healthcare
Bibliographic Information
| Print publication date: 2017 |
Print ISBN-13: 9780190206567 |
| Published to Oxford Scholarship Online: November 2016 |
DOI:10.1093/acprof:oso/9780190206567.001.0001 |
