The Difficulties of Ethical Theories of Justice in Health Care - Bioethics

Difficulties of ethical theories of justice in health care

Different ethical theories, as we have seen, are based on different ideas and different ideas reflecting the value of justice. Each of these theories is facing its own problems.

Among the ethical approaches considered, one should first of all note the confrontation of utilitarianism and egalitarianism. It clearly demonstrates the difference in the understanding of equitable distribution in health care. With a certain degree of conventionality, this difference can be characterized as follows. Utilitarianism is oriented to a greater extent on the aggregate benefit for society as a whole, and not for individuals, and egalitarianism, on the contrary, seeks to protect the interests of each individual (at least to some extent).

Egalitarianism comes from an attractive idea to ensure the equality of people in access to medical care, exclude the possibility that someone will not have access to medical benefits. But how exactly can this be done? After all, with limited resources and the need to restrain the growth of health care costs, this task is not achievable to any satisfactory extent.

As a result, in the mainstream of egalitarian concepts, the idea of ​​a reasonable minimum of medical care arose, which must be guaranteed to every individual. Thus, it is supposed that injustice in access to medical care for needy people would be prevented, while cost growth would be contained. However, the attempt to find a criterion for such a reasonable minimum encountered many difficulties.

These difficulties follow from the diversity of health care needs and specific situations. How to determine a reasonable minimum - as one for all, regardless of age, sex, characteristics of the disease or life situation, etc.? Or the reasonable minimum should vary depending on features of this or that individual? Should we limit ourselves to only the simplest and cheapest interventions, or should effective, but costly interventions (for example, dialysis or transplantation) also be included in a reasonable minimum? How to determine a reasonable minimum for incurable chronic diseases or for people with disabilities?

There are a lot of objections to the contractualism of Rawls - Daniels. Thus, this concept gives preference to the restoration of normal functioning, but in this case there can be injustice in relation to those who are not able to achieve it. Further, it is not clear what the level typical for the human species means, since people can have significant deviations in their physical state from the average concept of norm. How to relate to the fact that with age, the ability of normal functioning is increasingly reduced, and how is this reflected in the fair provision of medical care depending on age?

The utilitarian approach also generates a lot of problems and is therefore repeatedly criticized. In particular, its orientation to the benefit to society as a whole and to the most effective allocation of resources leads to discrimination against certain groups of people. Those who have more expensive medical care needs or incurable conditions may be out of the reach of resource allocation. As a result, there is a danger of denial of medical care for a number of vulnerable groups (seriously ill, elderly, incompetent, etc.).

The libertarian approach, with its orientation to the free market, is also not able to provide access to medical benefits for all members of society, since under conditions of an entirely market distribution, poor people are deprived of the opportunity to freely purchase the services they need, and the state does not interfere in this situation, so that violate the functioning of the free market.

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