Justice and Procedure: How does “accountability for reasonableness” result in fair limit-setting decisions?
David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Rafael De Clercq
Jack Alan Reynolds
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Journal of Medical Ethics 35 (1):12-16 (2009)
orman Daniels’ theory of justice and health faces a serious practical problem: his theory can ground the special moral importance of health and allows distinguishing just from unjust health inequalities, but it provides little practical guidance for allocating resources when they are especially scarce. Daniels’ solution to this problem is a fair process that he specifies as "accountability for reasonableness". Daniels claims that accountability for reasonableness makes limit-setting decisions in healthcare not only legitimate, but also fair. This paper assesses the latter claim. Does accountability for reasonableness result in fair limit-setting decisions? It is argued that the answer to this question is not a clear yes. Daniels is remarkably unclear about the criterion of fairness that accountability for reasonableness satisfies. The paper discusses different options for resolving this lack of clarity and examines how they apply to Daniels’ accountability for reasonableness framework. It is concluded, first, that accountability for reasonableness is not a paradigm case of any of the classic notions of procedural justice; second, that what might be called "constrained pure procedural justice" best reflects how accountability for reasonableness results in fair limit-setting decisions; and third, that the procedural conditions of accountability for reasonableness must be further specified and amended to better achieve a fair process, and hence fair limit-setting decisions.
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Citations of this work BETA
Marco Huesch (2012). One and Done? Equality of Opportunity and Repeated Access to Scarce, Indivisible Medical Resources. BMC Medical Ethics 13 (1):11-.
Rui Nunes & Guilhermina Rego (2014). Priority Setting in Health Care: A Complementary Approach. [REVIEW] Health Care Analysis 22 (3):292-303.
Bridget Pratt, Deborah Zion & Bebe Loff (2012). Evaluating the Capacity of Theories of Justice to Serve as a Justice Framework for International Clinical Research. American Journal of Bioethics 12 (11):30-41.
Claudia Landwehr (2013). Procedural Justice and Democratic Institutional Design in Health-Care Priority-Setting. Contemporary Political Theory 12 (4):296.
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