Chapter 2: Normative Standards and Health Care Resource Management
* 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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