Distributive Justice and the New Medicine
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Distributive Justice and the New Medicine

George P. Smith II

The author begins by examining various economic constructs as aids for achieving a fair and equitable delivery of health care services. He then assesses their level of practical application and evaluates the costs and benefits to society of pursuing the development and use of the ‘New Medicine’. The book ends with a case study of organ and tissue transplantation that illustrates the implementation of distributive justice. The author concludes that as long as clinical medicine maintains its focus on healing and alleviating suffering among patients, a point of equilibrium will be reached that advances the common good.
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Chapter 2: Normative Standards and Health Care Resource Management

George P. Smith II


* INTRODUCTION Controlling costs while limiting access to health care resources and constraining choices thereto is the central dilemma confronting health care policy today.1 One overriding point is clear: namely, so long as restrictive levels of use for health resources exist, some principle of “maximum societal benefit” must be set. Accordingly, the individual’s unfettered right to access and equality of use must—to some extent—be compromised in order to safeguard the general need.2 No definitive structure for normative decision making in health care resource management will be constructed in this chapter. Indeed, finding what may be considered a “just” solution to the selective distribution of finite health care resources is a task of great, overpowering magnitude and perhaps a “near impossibility.”3 The health care compromises made, the values and public policies used to shape them, and the framework within which they operate presently, will—however— be analysed. To that end, the economic, medical, ethical and socio-legal underpinnings of the frameworks or models for decision making will be examined critically as well as the conflicts and challenges arising from their application. The vast complexities and philosophical nuances of the subject area, together with limitations of space imposed, dictate—necessarily— an analytical approach that is restricted in the scope and depth of its criticism. What will emerge, however, is a foundational evaluation of the core considerations, or perhaps principles, which—of necessity—guide in conflict resolutions regarding allocations of health care resources. These considerations, in turn, need...

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