Iwao Hirose

Should organ transplants be given to patients who have waited the longest, or need it most urgently, or those whose survival prospects are the best? The rationing of health care is universal and inevitable, taking place in poor and affluent countries, in publicly funded and private health care systems. Someone must budget for as well as dispense health care whilst aging populations severely stretch the availability of resources. The Ethics of Health Care Rationing is a clear and much-needed introduction to this increasingly important topic, considering and assessing the major ethical problems and dilemmas about the allocation, scarcity and rationing of health care. Beginning with a helpful overview of why rationing is an ethical problem, the authors examine the following key topics: What is the value of health? How can it be measured? What does it mean that a treatment is "good value for money"? What sort of distributive principles - utilitarian, egalitarian or prioritarian - should we rely on when thinking about health care rationing? Does rationing health care unfairly discriminate against the elderly and people with disabilities? Should patients be held responsible for their health? Why does the debate on responsibility for health lead to issues about socioeconomic status and social inequality? Throughout the book, examples from the US, UK and other countries are used to illustrate the ethical issues at stake. Additional features such as chapter summaries, annotated further reading and discussion questions make this an ideal starting point for students new to the subject, not only in philosophy but also in closely related fields such as politics, health economics, public health, medicine, nursing and social work.

In this dissertation, I discuss two distributive principles in moral philosophy: Derek Parfit's Prioritarianism and Egalitarianism. I attempt to defend a version of Egalitarianism, which I call Weighted Egalitarianism. Although Parfit claims that Egalitarianism is subject to what he calls the Levelling Down Objection, I show that my proposed Weighted Egalitarianism is not subject to the Objection, and that it gives priority to the worse off people. The real difference between the two principles lies in how the weight of each person's well-being is determined. Prioritarianism assumes that there is a moral scale of the goodness of well-being, independently of distributions of people's well-being. I raise two objections to this claim: firstly, it is hard to believe that the choice of the level of well-being affects our distributive judgement; secondly, it is hard to believe that there is such a moral scale independently of distributions of people's well-being. On the other hand, Weighted Egalitarianism claims that the weight is given by the rank order position of the person in the ranking by well-being level. This means that, in Weighted Egalitarianism, the goodness of a distribution is an increasing, linear function of people's well-being. Weighted Egalitarianism is not affected by the choice of the level of people's well-being. Nor does it require require the moral scale of the goodness of well-being independently of distributions of people's well-being. Leximin, which might be a version of Prioritarianism, avoids my objections. But it is hard to support Leximin, because it rules out the trade off between the better off and the worse off. I conclude that Weighted Egalitarianism is more acceptable than Prioritarianism.