By comparing models of market-based allocation with state-controlled national health care systems, it will be suggested that the way in which different communicaties deal with the allocation of health care is central to their expression of what might be called a moral self-understanding. That is to say that the provision of health care may be expected to be a focus of communal debate, not simply about morally acceptable and unacceptable actions, but also about the community’s understanding of what it is (...) that makes for a worthwhile and morally defensible human life. This moral self-understanding is seen to be entwined with the different concepts of ‘health’ that are implicit in different systems of allocation. In conclusion, it will be suggested that decisions concerning health care allocation must be made in response to a continuing, public and open debate about that health and health care mean to a particular community. (shrink)

Physicians are increasingly confronted with the consequences of allocation policies. In several countries, physicians have been assigned a gatekeeper role for secondary health care. Many ethicists oppose this assignment for several reasons, concentrating on the harm the intrusion of societal arguments would inflict on doctor-patient relations. It is argued that these arguments rest on a distinction of spheres of values and of rationality, without taking into account the mixing of values and rationalities that takes place in everyday medical practice. If (...) medical practice, then, does not follow a single, pure rationality, can it also incorporate the societal rationality of the gatekeeper role?Using a case from general practice, I try to show how physicians may integrate societal arguments into their practice in a morally acceptable way. A version of the model of reflective equilibrium and especially Beauchamp and Childress's safeguards, may be helpful both to analyse and teach such balancing of values and rationalities. (shrink)

Mark J. Cherry; Foundations of the Culture Wars: Compassion, Love, and Human Dignity, Christian bioethics: Non-Ecumenical Studies in Medical Morality, Volume 7.