Abstract

The increasing willingness of people to agree that societies currently spend too much on health care is noted. It is argued that this is more an expression of financial pressures on the state than a reflection of new technological possibilities. The meaning of such statements is questioned in the context of demonstrated social underutilization of skilled personnel and wasteful expenditure. The discussion then focusses on approaches to defining medical need in clinical situations. It is pointed out that this issue has risen to prominence with the establishment of a right to care and the subsequent attempt to define limits to this right. Two basic approaches, the scientific and the subjective, are presented and both are shown to be incapable of providing absolute criteria for decision-making. It is concluded that the issue of establishing needs is a complex technical and political one, where medical ethics can contribute by clarifying the issues and illuminating the alternatives.