Macroallocation of health care resources as distributive justice

There are many ways in which and by which a society might choose to distribute health care goods and services, from laissez-faire "pay as you go" medical delivery to highly structured resource distribution. What sort of distributional system, however, is truly just? This thesis seeks to examine the question of justice in the way in which a society allocates health care. The approach to this problem is one of applied medical ethics. The justice theories of such writers as John Rawls, Karl Marx, and John Stuart Mills is contrasted with the actual history of health care distribution in the United States since its colonial period. These provide a background of varying concepts, both theoretical and actual, of what justice in health care distribution actually is.

The problem is put in the language of desert-claims, which is to ask, "By virtue of what may a person be said to be deserving of health care?". Some writers have suggested that a person merits health care merely by virtue of being in need of health care. This position is rejected as being unsubstantiable; needing health care is a necessary, but not suf icient, factor for receiving health care goods and services. It is shown that some other consideration, such as a commitment to provide health care, is necessary to establish a claim of desert for the provision of health care. This understanding of distributive justice is derived from a basic ethical commitment to the sovereignty of the individual.