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Towards an Integrative Model of Allocative Health Care Justice: Egalitarianism, Prioritarianism, Sufficientarianism

Applicant Leist Anton
Number 120200
Funding scheme Project funding (Div. I-III)
Research institution Ethik-Zentrum Universität Zürich
Institution of higher education University of Zurich - ZH
Main discipline Philosophy
Start/End 01.09.2008 - 31.12.2012
Approved amount 326'603.00
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Keywords (12)

Justice; Health care; Rationing; allocation; egalitarianism; prioritarianism; sufficientarianism; health; cardiac surgery; depression; elderly; respect

Lay Summary (English)

Lay summary
The project aims to develop standards for the just allocation of medical resources, as called for in the recent report of the working group on rationing of the Swiss Academy of Medical Sciences. This is to be done exemplarily in three important areas of health care, a concrete goal to be achieved on the basis of the theoretical clarification of the relationship between egalitarian, prioritarian and sufficientarian elements in allocative justice. The investigation proceeds from the hypothesis that the requisite theory cannot plausibly be monistic in form, but must consist in an ordered set of principles incorporating elements from each of these theory types.Part 1 of the project aims to defend egalitarian standards, in particular against the levelling down objection. Starting from the conceptual claim that justice is a matter of giving individuals their due, the discussion of egalitarianism will focus constructively on the concept of respect as it occurs in health care contexts, seeking to clarify what the application of the concept demands and what it excludes. Part 2 turns to prioritarian concerns, asking after the varying content and normative status of worst-offness in health matters. The discussion will be structured around two questions: firstly, the comparative weight or weighability of death and other health-related ills and secondly, the normative relationship between conditions of persons-at-times and persons' complete lives. Part 3 of the investigation seeks an explanation for the ineradicability of both "absolute" (prioritarian and sufficientarian) and relational (egalitarian) standards of justice by turning to their psychological sources. The - broadly Humean - hypothesis here is that, whereas the former ground in empathy, the latter ground in an irreducible relational concern with unequal distributions, a concern that can by no means, as critics have claimed, be identified with envy.Finally, Part 4 of the project brings this hybrid conception to bear on three concrete areas of health care. These have been chosen because they allow us to discuss specific constellations of the previously analysed factors, constellations that are increasingly complex and appear to exert normative pulls in different directions. (a) Because in cardiac surgery present endangerment seems to trump longer periods of ill-being, it raises particularly starkly the question of the temporal reference point of allocative criteria. (b) As an illness that, firstly, can be acutely disabling as well as blighting longer periods of lives and, secondly, can involve (temporary) loss of rationality, major depression seems to demand different conceptualisations both of respect and of the normatively relevant temporal framework. Finally (c), the question of what is due to the elderly as a matter of justice forces additional consideration of whether larger numbers of years "accumulated" and of smaller numbers potentially still liveable are legitimate moral considerations in the face of the demand for respect and for concern for present fragility, suffering and possible loss of rational capacities.
Direct link to Lay Summary Last update: 21.02.2013

Responsible applicant and co-applicants



What do theories of social justice have to say about health care rationing? Well-­being, sufficiency and explicit age-­rationing
Fourie C (2012), What do theories of social justice have to say about health care rationing? Well-­being, sufficiency and explicit age-­rationing, in Andre den Exeter, Martin Buijsen (ed.), Maklu, Antwerpen, 65-86.
What is Social Equality? An Analysis of Status Equality as a Strongly Egalitarian Ideal
Fourie C (2011), What is Social Equality? An Analysis of Status Equality as a Strongly Egalitarian Ideal, in Res Publica, 1-20.

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
Edge Discussion Group 10.11.2011 Ann Arbor, MI, USA
Philosophy Colloquium 21.10.2011 Ann Arbor, MI, USA
Distributive justice in health 05.10.2011 Braga, Portugal
MANCEPT workshops on political theory 31.08.2011 Manchester, UK
Health Care Rationing 09.12.2010 Rotterdam, Netherlands
Conference on Applied Ethics 05.11.2010 Sapporo, Japan


Title Year
Visiting Scholarship, University of Michigan 2011

Associated projects

Number Title Start Funding scheme
136125 Is ’Enough’ Enough? The Relevance of Sufficiency for Just Health Care 01.06.2011 Scientific Conferences
147446 The Social Gradient in Health: Normative, Empirical and Policy Perspectives 01.05.2013 Scientific Conferences
146668 Equality in health, equality for health: Justice, status and the social gradient in health 01.01.2014 Project funding (Div. I-III)