Lead


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.