Abstract

This paper maps the different levels of the problem of healthcare resource allocation — micro, macro and international — with reference to three cases. It is argued that two standard approaches to the issue of distributive justice in healthcare, the QALY (quality-adjusted life year) approach and the social-contract approach developed by Norman Daniels, are fundamentally unsatisfactory for reasons identified by Alasdair MacIntyre. Although the virtue theory articulated by MacIntyre and others has been influential in many areas of healthcare ethics, there seems to have been relatively little discussion of the difference it might make to the problems of resource allocation. The potential of such an approach is explored in the later sections of the paper. Two apparently promising ways of bringing virtue ethics to bear on resource allocation are examined and found wanting to greater or lesser extents. Firstly, Beauchamp and Childress’s account of the virtues as a supplement to their ‘Four Principles’ is found to have little or no substantive contribution to make to this issue. Secondly, the ‘liberal communitarian’ system of resource allocation proposed by Ezekiel Emanuel, while a considerable improvement on the account of Beauchamp and Childress, remains problematic in some respects. An alternative Christian account is developed by identifying significant influences that might shape the ‘political prudence’ which would enable Christian communities to form sound judgments about distributive justice in healthcare. The paper concludes with some remarks about the relationship between this tradition-constituted account and the wider public sphere of policy-making and practice