Priority setting, justice, and health care: conceptual analysis

In this paper, priority setting in health care is defined as distributional decisions at the individual level involving clear and direct limitation of access to beneficial health care according to some categorical criterion other than the market. The justification of a particular rule of priority setting depends on conceptual issues as well as on the choice of value premises. Especially important is the type of scarcity involved (whether the imbalance between supply and need can be overcome or not) and the concept of justice used or presupposed (for instance, whether the conception of justice emphasizes efficiency or fairness or both). The proposal put forward is that the task of medical ethics is to provide conceptual clarification and value premises relevant to justify rules of priority setting. The actual choice of such rules belongs primarily to the domain of politics.