Justice et santé. Chacun doit-il recevoir des soins en proportion de ses besoins ?

Abstract
Lorsqu'il est question de distribuer les soins de santé de manière juste, le critère qui est le plus souvent spontanément proposé est le besoin. Il faut soigner chacun selon ses besoins. Dans cette étude, nous examinons la signification de ce critère et ses limites. Il apparaît en effet, dès qu'on entre dans les détails, qu'on rencontre de graves difficultés lorsqu'on veut l'appliquer. Ces difficultés sont conceptuelles (le besoin a plusieurs significations) et substantielles (le besoin est insuffisant comme critère). Nous concluons que la justice demande qu'on abandonne au moins partiellement l'approche de haut en bas (l'application d'un critère aux cas particuliers) au profit d'une approche de bas en haut, laissant plus de place au patient comme autorité de décision. When we consider just distribution of health care, the criterion we usually encounter is need. We must treat patients proportionally to their needs. In this paper, we examine the meaning and limits of this criterion. As soon as we go into the details, we encounter serious difficulties in its application. Those difficulties are conceptual (need has various meanings) and substantial (need is not enough as a criterion).We conclude that justice requires a partial renunciation to a top-down approach (application of a criterion to particular cases) on behalf of a bottom-up one, giving more weight to the patient, as an authority of choice.
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