Abstract

This essay addresses how people's disadvantage should affect their priority for health-care resources. Chapter One considers what kind of disadvantage should count in allocations of health-care resources. I argue that health disadvantage, but not general disadvantage, should count. ;Chapter Two shows that revised interpretations of Norman Daniels' principles of fair equality of opportunity and of beneficence can explain the importance of health-care resources in everyone with disadvantage due to health impairments or inferior natural endowments. I justify these revisions. ;Chapter Three argues that worse expected health, younger age, and shorter life expectancy are reasons to give people greater prima facie priority for health-care resources. I show that prior health should factor into decisions about allocations that target public health, but not into decisions about the delivery of personal medical services. I argue that decisions about allocations of lifesaving resources should ignore differences in health outcomes, provided that people will have sufficient mental capacity to appreciate life's meaning. ;Chapter Four investigates whether a proportional expression of people's health gains satisfactorily expresses the moral importance of health benefits in light of people's health disadvantage. The worse the disadvantage, the greater the proportional gain that a given benefit represents. I conclude that the proportional-utility-gain approach may be helpful in a range of cases, but several problems need resolution before we can reach any final conclusions. Whether they can be resolved is unclear. ;Chapter Five argues that a two-step democratic process is a promising way to determine exactly how to balance health disadvantage and benefit in making allocation decisions. Step one involves the solicitation of so-called 'person tradeoffs' from the general population. In step two, these tradeoff data flow to a policymaking body. I argue that a group process of reflection and decisionmaking is critical for both steps. I draw on accounts of deliberative democracy. I argue that deliberators should be open to diverse forms of expression, including stories and emotion-laden speech acts. I address how this deliberative process protects minorities. This concludes the essay