Abstract

This work critically examines the philosophical basis underlying methods of health-care distribution. It advocates taking an inclusive view in which access, availability, uptake, and quality all form part of the process of evaluation. Different methods of health-care organization are considered and I examine models for distributing health-care, specifically in the US, UK, and Australia. Concerns are addressed in terms of how systems are evaluated, as well as meanings attached to key terms such as equity and equality. Meeting the health-care needs of whole populations places demands on a number of social institutions, and while reform is essentially a political process, philosophical considerations require examining the basis of interaction between law, morality and justice. This study seeks to establish a conceptual framework in which public policy considerations and distributive justice can be assessed, according to ethical criteria and jurisprudential reasoning. It considers the social justice implications of poor distribution, uncertain quality of care, and the question of medical error. It also examines the so-called right to health-care, and the basis of distribution and redistribution of assets within society. To this end, different ethical theories are discussed, starting with Aristotelian conceptions of justice, the application of utilitarian ideals, and modern deontological conceptions of justice in relation to health-care. In analyzing principles of justice and the relationship between law and morality, the assertion is made that contemporary legal theory can be usefully employed in helping to construct an ethical framework for determining public policy on health-care distribution