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  1. Rights, Reasonableness, and Environmental Harms.Matt Zwolinski - 2018 - American Journal of Bioethics 18 (3):46-48.
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  • Democratizing Algorithmic Fairness.Pak-Hang Wong - 2020 - Philosophy and Technology 33 (2):225-244.
    Algorithms can now identify patterns and correlations in the (big) datasets, and predict outcomes based on those identified patterns and correlations with the use of machine learning techniques and big data, decisions can then be made by algorithms themselves in accordance with the predicted outcomes. Yet, algorithms can inherit questionable values from the datasets and acquire biases in the course of (machine) learning, and automated algorithmic decision-making makes it more difficult for people to see algorithms as biased. While researchers have (...)
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  • Evidence, Ethics and Inclusion: A Broader Base for NICE. [REVIEW]Stephen Wilmot - 2011 - Medicine, Health Care and Philosophy 14 (2):111-121.
    The National Institute for Health and Clinical Excellence (hereafter NICE) was created in 1998 to give guidance on which treatments should be provided by the British National Health Service, and to whom. So it has a crucial role as an agent of distributive justice. In this paper I argue that it is failing to adequately explain and justify its decisions in the public arena, particularly in terms of distributive justice; and that this weakens its legitimacy, to the detriment of the (...)
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  • A Framework for Risk-Benefit Evaluations in Biomedical Research.Annette Rid & David Wendler - 2011 - Kennedy Institute of Ethics Journal 21 (2):141-179.
    One of the key ethical requirements for biomedical research is that it have an acceptable risk-benefit profile (Emanuel, Wendler, and Grady 2000). The International Conference of Harmonization guidelines mandate that clinical trials should be initiated and continued only if “the anticipated benefits justify the risks” (1996). Guidelines from the Council for International Organizations of Medical Sciences state that biomedical research is acceptable only if the “potential benefits and risks are reasonably balanced” (2002). U.S. federal regulations require that the “risks to (...)
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  • Diamond and Daniels on Medical Rationing.Walter Glannon - 1999 - Economics and Philosophy 15 (1):119-125.
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  • Report's Framework Offers Good Foundation for Future Prioritization of Health Care That is Applicable Across Health Care Systems.Lauri Vuorenkoski - 2004 - American Journal of Bioethics 4 (3):108-110.
  • The Secret Art of Managing Healthcare Expenses: Investigating Implicit Rationing and Autonomy in Public Healthcare Systems.S. M. R. Lauridsen, M. S. Norup & P. J. H. Rossel - 2007 - Journal of Medical Ethics 33 (12):704-707.
    Rationing healthcare is a difficult task, which includes preventing patients from accessing potentially beneficial treatments. Proponents of implicit rationing argue that politicians cannot resist pressure from strong patient groups for treatments and conclude that physicians should ration without informing patients or the public. The authors subdivide this specific programme of implicit rationing, or “hidden rationing”, into local hidden rationing, unsophisticated global hidden rationing and sophisticated global hidden rationing. They evaluate the appropriateness of these methods of rationing from the perspectives of (...)
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  • Evidence Based Medicine Guidelines: A Solution to Rationing or Politics Disguised as Science?S. I. Saarni - 2004 - Journal of Medical Ethics 30 (2):171-175.
    “Evidence based medicine” is often seen as a scientific tool for quality improvement, even though its application requires the combination of scientific facts with value judgments and the costing of different treatments. How this is done depends on whether we approach the problem from the perspective of individual patients, doctors, or public health administrators. Evidence based medicine exerts a fundamental influence on certain key aspects of medical professionalism. Since, when clinical practice guidelines are created, costs affect the content of EBM, (...)
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  • Clinical Ethics Revisited.Peter Singer, Edmund Pellegrino & Mark Siegler - 2001 - BMC Medical Ethics 2 (1):1-8.
    A decade ago, we reviewed the field of clinical ethics; assessed its progress in research, education, and ethics committees and consultation; and made predictions about the future of the field. In this article, we revisit clinical ethics to examine our earlier observations, highlight key developments, and discuss remaining challenges for clinical ethics, including the need to develop a global perspective on clinical ethics problems.
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  • Human Rights Against Polluters: More Than Protecting “Susceptible” Populations.Kristin Shrader-Frechette & Annrose Jerry - 2018 - American Journal of Bioethics 18 (3):44-46.
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  • Is the Community Consultation Requirement Necessary?Mark Sheehan - 2006 - American Journal of Bioethics 6 (3):38 – 40.
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  • In Defence of Governance: Ethics Review and Social Research.Mark Sheehan, Michael Dunn & Kate Sahan - 2018 - Journal of Medical Ethics 44 (10):710-716.
    There is a growing body of literature that has sought to undermine systems of ethical regulation, and governance more generally, within the social sciences. In this paper, we argue that any general claim for a system of research ethics governance in social research depends on clarifying the nature of the stake that society has in research. We show that certain accounts of this stake—protecting researchers’ freedoms; ensuring accountability for resources; safeguarding welfare; and supporting democracy—raise relevant ethical considerations that are reasonably (...)
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  • The Use of Cost-Effectiveness by the National Institute for Health and Clinical Excellence (NICE): No(T yet an) Exemplar of a Deliberative Process.M. Schlander - 2008 - Journal of Medical Ethics 34 (7):534-539.
    Democratic societies find it difficult to reach consensus concerning principles for healthcare distribution in the face of resource constraints. At the same time the need for legitimacy of allocation decisions has been recognised. Against this background, the National Institute for Health and Clinical Excellence (NICE) aspires to meet the principles of procedural justice, specifically the conditions of accountability for reasonableness as espoused by Daniels and Sabin, that is, publicity, relevance, revisions and appeal, and enforcement. Although NICE has adopted a highly (...)
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  • Principles Versus Procedures in Making Health Care Coverage Decisions: Addressing Inevitable Conflicts.Lindsay M. Sabik & Reidar K. Lie - 2008 - Theoretical Medicine and Bioethics 29 (2):73-85.
    It has been suggested that focusing on procedures when setting priorities for health care avoids the conflicts that arise when attempting to agree on principles. A prominent example of this approach is “accountability for reasonableness.” We will argue that the same problem arises with procedural accounts; reasonable people will disagree about central elements in the process. We consider the procedural condition of appeal process and three examples of conflicts over coverage decisions: a patients’ rights law in Norway, health technologies coverage (...)
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  • Unpredictable Drug Shortages: An Ethical Framework for Short-Term Rationing in Hospitals.Philip M. Rosoff - 2012 - American Journal of Bioethics 12 (1):1 - 9.
    Periodic and unexpected shortages of drugs, biologics, and even medical devices have become commonplace in the United States. When shortages occur, hospitals and clinics need to decide how to ration their available stock. When such situations arise, institutions can choose from several different allocation schemes, such as first-come, first-served, a lottery, or a more rational and calculated approach. While the first two approaches sound reasonable at first glance, there are a number of problems associated with them, including the inability to (...)
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  • Healthcare Rationing Cutoffs and Sorites Indeterminacy.Philip M. Rosoff - 2019 - Journal of Medicine and Philosophy 44 (4):479-506.
    Rationing is an unavoidable mechanism for reining in healthcare costs. It entails establishing cutoff points that distinguish between what is and is not offered or available to patients. When the resource to be distributed is defined by vague and indeterminate terms such as “beneficial,” “effective,” or even “futile,” the ability to draw meaningful boundary lines that are both ethically and medically sound is problematic. In this article, I draw a parallel between the challenges posed by this problem and the ancient (...)
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  • Justice and Procedure: How Does “Accountability for Reasonableness” Result in Fair Limit-Setting Decisions?Annette Rid - 2009 - Journal of Medical Ethics 35 (1):12-16.
    orman Daniels’ theory of justice and health faces a serious practical problem: his theory can ground the special moral importance of health and allows distinguishing just from unjust health inequalities, but it provides little practical guidance for allocating resources when they are especially scarce. Daniels’ solution to this problem is a fair process that he specifies as "accountability for reasonableness". Daniels claims that accountability for reasonableness makes limit-setting decisions in healthcare not only legitimate, but also fair. This paper assesses the (...)
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  • Medicine and Contextual Justice.Rosamond Rhodes - 2018 - Cambridge Quarterly of Healthcare Ethics 27 (2):228-249.
    :This article provides a critique of the monolithic accounts that define justice in terms of a single and often inappropriate goal. By providing an array of real examples, I argue that there is no simple definition of justice, because allocations that express justice are governed by a variety of reasons that reasonable people endorse for their saliency. In making difficult choices about ranking priorities, different considerations have different importance in different kinds of situations. In this sense,justice is a conclusionabout whether (...)
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  • Ethical Dilemmas in Protecting Susceptible Subpopulations From Environmental Health Risks: Liberty, Utility, Fairness, and Accountability for Reasonableness.David B. Resnik, D. Robert MacDougall & Elise M. Smith - 2018 - American Journal of Bioethics 18 (3):29-41.
    Various U.S. laws, such as the Clean Air Act and the Food Quality Protection Act, require additional protections for susceptible subpopulations who face greater environmental health risks. The main ethical rationale for providing these protections is to ensure that environmental health risks are distributed fairly. In this article, we consider how several influential theories of justice deal with issues related to the distribution of environmental health risks; show that these theories often fail to provide specific guidance concerning policy choices; and (...)
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  • Pharmacogenetic Interventions, Orphan Drugs, and Distributive Justice: The Role of Cost-Benefit Analysis.Arti K. Rai - 2002 - Social Philosophy and Policy 19 (2):246-270.
    With the human genome mapped, and with the mapping of more than one hundred animal genomes in progress, the amount of genetic data available is increasing exponentially. This exponential increase in data is having an immediate impact on the process of drug development. By using techniques of information technology to manipulate data regarding the genes, proteins, and biochemical pathways associated with various diseases, scientists are beginning to be able to design drugs in a systematic fashion. In the context of any (...)
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  • Exploring the Ethics of Global Health Research Priority-Setting.Bridget Pratt, Mark Sheehan, Nicola Barsdorf & Adnan A. Hyder - 2018 - BMC Medical Ethics 19 (1):94.
    Thus far, little work in bioethics has specifically focused on global health research priority-setting. Yet features of global health research priority-setting raise ethical considerations and concerns related to health justice. For example, such processes are often exclusively disease-driven, meaning they rely heavily on burden of disease considerations. They, therefore, tend to undervalue non-biomedical research topics, which have been identified as essential to helping reduce health disparities. In recognition of these ethical concerns and the limited scholarship and dialogue addressing them, we (...)
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  • Ensuring That We Promote Participation in Health for Everyone.Andrew D. Plunk & Sarah Gehlert - 2014 - American Journal of Bioethics 14 (6):19-20.
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  • Do Healthcare Professionals Have Different Views About Healthcare Rationing Than College Students? A Mixed Methods Study in Portugal.Micaela Pinho, Ana Pinto Borges & Richard Cookson - 2018 - Public Health Ethics 11 (1):90-102.
    The main aim of this paper is to investigate the views of healthcare professionals in Portugal about healthcare rationing, and compare them with the views of college students. A self-administered questionnaire was used to collect data from a sample of 60 healthcare professionals and 180 college students. Respondents faced a hypothetical rationing dilemma where they had to order four patients and justify their choices. Multinomial logistic regressions were used to test for differences in orderings, and content analysis to categorize the (...)
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  • In a Democracy, What Should a Healthcare System Do? A Dilemma for Public Policymakers.Malcolm Oswald - 2013 - Politics, Philosophy and Economics (1):1470594-13497670.
    In modern representative democracies, much healthcare is publicly funded or provided and so the question of what healthcare systems should do is a matter of public policy. Given that public resources are inevitably limited, what should be done and who should benefit from healthcare? It is a dilemma for policymakers and a subject of debate within several disciplines, but rarely across disciplines. In this paper, I draw on thinking from several disciplines and especially philosophy, economics, and systems theory. I conclude (...)
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  • In a Democracy, What Should a Healthcare System Do? A Dilemma for Public Policymakers.Malcolm Oswald - 2015 - Politics, Philosophy and Economics 14 (1):23-52.
    In modern representative democracies, much healthcare is publicly funded or provided and so the question of what healthcare systems should do is a matter of public policy. Given that public resources are inevitably limited, what should be done and who should benefit from healthcare? It is a dilemma for policymakers and a subject of debate within several disciplines, but rarely across disciplines. In this paper, I draw on thinking from several disciplines and especially philosophy, economics, and systems theory. I conclude (...)
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  • Rules is Rules.Robert D. Orr - 2006 - American Journal of Bioethics 6 (3):40 – 41.
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  • Antimicrobial Stewardship Programmes: Bedside Rationing by Another Name?Simon Oczkowski - 2017 - Journal of Medical Ethics 43 (10):684-687.
    Antimicrobial therapy is a cornerstone of therapy in critically ill patients; however, the wide use of antibiotics has resulted in increased antimicrobial resistance and outbreaks of resistant disease. To counter this, many hospitals have instituted antimicrobial stewardship programmes as a way to reduce the inappropriate use of antibiotics. However, uptake of antimicrobial stewardship programmes has been variable, as many clinicians fear that they may put individual patients at risk of treatment failure. In this paper, I argue that antimicrobial stewardship programmes (...)
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  • How Should What Economists Call “Social Values” Be Measured?Martha C. Nussbaum - 1999 - The Journal of Ethics 3 (3):249-273.
    Most economists and some philosophers distinguish individual utilities from interpersonal social values. Even if challenges to that conceptual distinction can be met, further philosophically interesting questions arise. I pursue three in this paper, using, as context for the discussion, health economics and its attempt to discern empirically a social welfare function to help guide rationing decisions. (1) To discern these utilities and values in a manner that is morally appropriate if they are to influence rationing decisions, who should be queried? (...)
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  • Priority Setting in Health Care: A Complementary Approach. [REVIEW]Rui Nunes & Guilhermina Rego - 2014 - Health Care Analysis 22 (3):292-303.
    Explicit forms of rationing have already been implemented in some countries, and many of these prioritization systems resort to Norman Daniels’ “accountability for reasonableness” methodology. However, a question still remains: is “accountability for reasonableness” not only legitimate but also fair? The objective of this paper is to try to adjust “accountability for reasonableness” to the World Health Organization’s holistic view of health and propose an evolutionary perspective in relation to the “normal” functioning standard proposed by Norman Daniels. To accomplish this (...)
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  • Public Accountability and Sunshine Healthcare Regulation.Rui Nunes, Cristina Brandão & Guilhermina Rego - 2011 - Health Care Analysis 19 (4):352-364.
    The lack of economic sustainability of most healthcare systems and a higher demand for quality and safety has contributed to the development of regulation as a decisive factor for modernisation, innovation and competitiveness in the health sector. The aim of this paper is to determine the importance of the principle of public accountability in healthcare regulation, stressing the fact that sunshine regulation—as a direct and transparent control over health activities—is vital for an effective regulatory activity, for an appropriate supervision of (...)
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  • Healthcare Regulation as a Tool for Public Accountability.Rui Nunes, Guilhermina Rego & Cristina Brandão - 2009 - Medicine, Health Care and Philosophy 12 (3):257-264.
    The increasing costs of healthcare delivery led to different political and administrative approaches trying to preserve the core values of the welfare state. This approach has well documented weaknesses namely with regard to healthcare rationing. The objective of this paper is to evaluate if independent healthcare regulation is an important tool with regard to the construction of fair processes for setting limits to healthcare. Methodologically the authors depart from Norman Daniels’ and James Sabin’s theory of accountability for reasonableness and try (...)
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  • The Role of Evidence in Health Policy Making: A Normative Perspective.Ole Frithjof Norheim - 2002 - Health Care Analysis 10 (3):309-317.
    Assessment of evidence is becoming a centralpart of health policy decisions – not least inlimit setting decisions. Limit-settingdecisions can be defined as the withholding ofpotentially beneficial health care. Thisarticle seeks to explore the value choicesrelated to the use of evidence in limit-settingdecisions at the political level. To betterspecify the important but restricted role ofevidence in such decisions, the value choicesof relevance are discussed explicitly. Fourcriteria are often considered when settinglimits:1. The severity of disease if untreated or treatedby standard care2. The (...)
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  • The Institutions of Deliberative Democracy.William Nelson - 2000 - Social Philosophy and Policy 17 (1):181.
    This paper addresses two questions. First, how different is the ideal underlying deliberative democracy from the ideal expressed in contemporary liberal theory, especially contractualist theory and "political liberalism"? Second, what specific institutional prescriptions, if any, follow from deliberative democracy? It is argued that the deliberative ideal has become quite abstract and, in fact, does not differ significantly from many forms of contemporary liberalism. Moreover, it is something of an open question just what institutions best realize this ideal. Specifically, the ideal (...)
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  • Should Research Ethics Committees Meet in Public?M. Sheehan - 2008 - Journal of Medical Ethics 34 (8):631-635.
    Currently, research ethics committees in the UK meet behind closed doors—their workings and most of the content of their decisions are unavailable to the general public. There is a significant tension between this current practice and a broader societal presumption of openness. As a form of public institution, the REC system exists to oversee research from the perspective of society generally.An important part of this tension turns on the kind of justification that might be offered for the REC system. In (...)
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  • Quality of Life: Erosions and Opportunities Under Managed Care.E. Haavi Morreim - 2000 - Journal of Law, Medicine and Ethics 28 (2):144-158.
    In recent years a number of commentators have discussed the importance of measuring quality of life in health care. We want to know whether an intervention will help people to live better, not just longer, and whether some treatments cause more trouble than they are worth. New technologies promise wondrous benefits. But when millions of people have no insured access to health care, and when many others face increasingly stringent limits on care, technologies’ high costs require us to choose what (...)
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  • Quality of Life: Erosions and Opportunities Under Managed Care.E. Haavi Morreim - 2000 - Journal of Law, Medicine and Ethics 28 (2):144-158.
    In recent years a number of commentators have discussed the importance of measuring quality of life in health care. We want to know whether an intervention will help people to live better, not just longer, and whether some treatments cause more trouble than they are worth. New technologies promise wondrous benefits. But when millions of people have no insured access to health care, and when many others face increasingly stringent limits on care, technologies’ high costs require us to choose what (...)
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  • Health Care: A Brave New World.Shelley Morrisette, William D. Oberman, Allison D. Watts & Joseph B. Beck - 2015 - Health Care Analysis 23 (1):88-105.
    The current U.S. health care system, with both rising costs and demands, is unsustainable. The combination of a sense of individual entitlement to health care and limited acceptance of individual responsibility with respect to personal health has contributed to a system which overspends and underperforms. This sense of entitlement has its roots in a perceived right to health care. Beginning with the so-called moral right to health care, the issue of who provides health care has evolved as individual rights have (...)
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  • Complete Lives, Short Lives, and the Challenge of Legitimacy.Paul T. Menzel - 2010 - American Journal of Bioethics 10 (4):50 – 52.
  • Precision and the Rules of Prioritization.John Mcmillan, Tony Hope & Dominic Wilkinson - 2013 - Cambridge Quarterly of Healthcare Ethics 22 (4):336-345.
  • Balancing Principles, QALYs and the Straw Men of Resource Allocation.John McMillan & Tony Hope - 2010 - American Journal of Bioethics 10 (4):48 – 50.
  • A Strategy to Improve Priority Setting in Health Care Institutions.Doug Martin & Peter Singer - 2003 - Health Care Analysis 11 (1):59-68.
    Priority setting (also known as resource allocation or rationing) occurs at every level of every health system and is one of the most significant health care policy questions of the 21st century. Because it is so prevalent and context specific, improving priority setting in a health system entails improving it in the institutions that constitute the system. But, how should this be done? Normative approaches are necessary because they help identify key values that clarify policy choices, but insufficient because different (...)
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  • Unjust Outcomes and Unfair Process?D. Robert MacDougall, Elise M. Smith & David B. Resnik - 2018 - American Journal of Bioethics 18 (4):10-12.
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  • Legitimate Allocation of Public Healthcare: Beyond Accountability for Reasonableness.Sigurd Lauridsen & Kasper Lippert-Rasmussen - 2009 - Public Health Ethics 2 (1):59-69.
    PhD, Institute of Public Health, Unit of Medical Philosophy and Clinical Theory, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099 1014 Copenhagen. Tel: +45 30 32 33 63; Email: s.lauridsen{at}pubhealth.ku.dk ' + u + '@ ' + d + ' '/ /- ->Citizens’ consent to political decisions is often regarded as a necessary condition of political legitimacy. Consequently, legitimate allocation of healthcare has seemed almost unattainable in contemporary pluralistic societies. The problem is that citizens do not agree on any (...)
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  • Administrative Gatekeeping – a Third Way Between Unrestricted Patient Advocacy and Bedside Rationing.Sigurd Lauridsen - 2009 - Bioethics 23 (5):311-320.
    The inevitable need for rationing of healthcare has apparently presented the medical profession with the dilemma of choosing the lesser of two evils. Physicians appear to be obliged to adopt either an implausible version of traditional professional ethics or an equally problematic ethics of bedside rationing. The former requires unrestricted advocacy of patients but prompts distrust, moral hazard and unfairness. The latter commits physicians to rationing at the bedside; but it is bound to introduce unfair inequalities among patients and lack (...)
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  • Procedural Justice and Democratic Institutional Design in Health-Care Priority-Setting.Claudia Landwehr - 2013 - Contemporary Political Theory 12 (4):296-317.
    Health-care goods are goods with peculiar properties, and where they are scarce, societies face potentially explosive distributional conflicts. Animated public and academic debates on the necessity and possible justice of limit-setting in health care have taken place in the last decades and have recently taken a turn toward procedural rather than substantial criteria for justice. This article argues that the most influential account of procedural justice in health-care rationing, presented by Daniels and Sabin, is indeterminate where concrete properties of rationing (...)
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  • Publish or Be Damned: Individual Funding Requests and the Publicity Condition.Monique Jonas, Anne Kolbe & Briar Warin - 2014 - Journal of Medical Ethics 40 (12):827-831.
  • Ethics and Opportunity Costs: Have NICE Grasped the Ethics of Priority Setting?J. McMillan - 2006 - Journal of Medical Ethics 32 (3):127-128.
    The Social Value Judgments consultation document reveals NICE’s failure to understand its role in healthcare prioritisationThe National Institute for Health and Clinical Excellence has published a draft guideline, Social Value Judgments: Guidelines for the Institute and its Advisory Bodies , which outlines the ethical framework that will guide its decision making in the future.1 NICE guidance has a profound effect upon the delivery of health care within the National Health Service so it is crucial that an overarching guideline such as (...)
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  • A Broader View of Justice.Nancy S. Jecker - 2008 - American Journal of Bioethics 8 (10):2 – 10.
    In this paper I argue that a narrow view of justice dominates the bioethics literature. I urge a broader view. As bioethicists, we often conceive of justice using a medical model. This model focuses attention at a particular point in time, namely, when someone who is already sick seeks access to scarce or expensive services. A medical model asks how we can fairly distribute those services. The broader view I endorse requires looking upstream, and asking how disease and suffering came (...)
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  • Conserving Scarce Resources: Willingness of Health Insurance Enrollees to Choose Cheaper Options.Samia A. Hurst, J. Russell Teagarden, Elizabeth Garrett & Ezekiel J. Emanuel - 2004 - Journal of Law, Medicine and Ethics 32 (3):496-499.
    Health care costs have been rising steadily in most industrialized countries. These increases are driven primarily by technological advances and, to a lesser degree, by aging of the population. Many factors make it unlikely that market forces alone will limit increases in the costs of health care. These unremitting increases make health care rationing appear both necessary and inevitable.One of the least controversial mechanisms for rationing could be to allow patients to make their own choices as to which kinds of (...)
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  • Allocating Resources in Humanitarian Medicine.Samia A. Hurst, Nathalie Mezger & Alex Mauron - 2009 - Public Health Ethics 2 (1):89-99.
    Fair resource allocation in humanitarian medicine is gaining in importance and complexity, but remains insufficiently explored. It raises specific issues regarding non-ideal fairness, global solidarity, legitimacy in non-governmental institutions and conflicts of interest. All would benefit from further exploration. We propose that some headway could be made by adapting existing frameworks of procedural fairness for use in humanitarian organizations. Despite the difficulties in applying it to humanitarian medicine, it is possible to partly adapt Daniels and Sabin's ‘Accountability for reasonableness’ to (...)
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