About this topic
Summary The allocation of medical resources is a subfield within more general concerns about distributive justice. As such, much discussion of healthcare allocation uses familiar terms and theories from this broader area. However, it is also a subject that has been seen by many to have particular importance, due to the central importance that health plays in human lives. Resource allocations are typically driven by two competing factors: 'efficiency' (on the grounds that we should want resources in a social institution like medicine to bring about more benefit rather than less) and 'equality' (on the grounds people can suffer to differing degrees from ill health, and we should have some preference to help those who are worse off). Broadly speaking, many discussions of health care allocation are discussions of how to understand, and how to make commensurable, these two competing considerations. More recently, there has also been a turn towards the idea that since there may be no single, uniquely acceptable way of allocating medical resources, a theory of fair medical allocation must include some discussion of procedural principles, i.e. principles that relate to the process by which actual allocation decisions are made. 
Key works Bognar & Hirose 2014 Daniels 2007
Introductions Cookson & Dolan 2000 Buchanan 1984
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  1. Teaching Residents to Consider Costs in Medical Decision Making.Elmer D. Abbo & Angelo E. Volandes - 2006 - American Journal of Bioethics 6 (4):33 – 34.
  2. Why U.S. Health Care Reform Is So Difficult.W. Andrew Achenbaum - 1994 - Hastings Center Report 24 (5):23-24.
  3. The Significance of a Wish.Felicia Ackerman - 1991 - Hastings Center Report 21 (4):27-29.
  4. Technology Assessment and Resource Allocation for Predictive Genetic Testing: A Study of the Perspectives of Canadian Genetic Health Care Providers.Alethea Adair, Robyn Hyde-Lay, Edna Einsiedel & Timothy Caulfield - 2009 - BMC Medical Ethics 10 (1):6-.
    With a growing number of genetic tests becoming available to the health and consumer markets, genetic health care providers in Canada are faced with the challenge of developing robust decision rules or guidelines to allocate a finite number of public resources. The objective of this study was to gain Canadian genetic health providers' perspectives on factors and criteria that influence and shape resource allocation decisions for publically funded predictive genetic testing in Canada. The authors conducted semi-structured interviews with 16 senior (...)
  5. Promoting Social Responsibility Amongst Health Care Users: Medical Tourists' Perspectives on an Information Sheet Regarding Ethical Concerns in Medical Tourism.Krystyna Adams, Jeremy Snyder, Valorie A. Crooks & Rory Johnston - 2013 - Philosophy, Ethics, and Humanities in Medicine 8:19.
    Medical tourists, persons that travel across international borders with the intention to access non-emergency medical care, may not be adequately informed of safety and ethical concerns related to the practice of medical tourism. Researchers indicate that the sources of information frequently used by medical tourists during their decision-making process may be biased and/or lack comprehensive information regarding individual safety and treatment outcomes, as well as potential impacts of the medical tourism industry on third parties. This paper explores the feedback from (...)
  6. The Ethics of Organ Tourism: Role Morality and Organ Transplantation.Marcus P. Adams - 2017 - Journal of Medicine and Philosophy 42 (6):670-689.
    Organ tourism occurs when individuals in countries with existing organ transplant procedures, such as the United States, are unable to procure an organ by using those transplant procedures in enough time to save their life. In this paper, I am concerned with the following question: When organ tourists return to the United States and need another transplant, do US transplant physicians have an obligation to place them on a transplant list? I argue that transplant physicians have a duty not to (...)
  7. Cost Analysis of the Utilization of New Vascular Grafts.Raphael Adar & Nava Pliskin - 1980 - Theoretical Medicine and Bioethics 1 (2):213-223.
    A cost analysis of the utilization of new expensive vascular grafts is performed, applying the methodology of decision analysis to the theoretical case of a sixty year old male patient undergoing femoropopliteal grafting for limb threatening ischemia. The problem is presented graphically as a decision tree, uncertainties are quantified in terms of probabilities and end outcomes are evaluated in monetary terms. This informations is then utilized to calculate cost values associated with alternative actions.Based on initial cumulative patency figures of the (...)
  8. On the Ethics of Medical Care Under Resource Constraints.Joseph Agassi - 2007 - Spontaneous Generations 1 (1):4.
  9. Incentives and Obligations Under Prospective Payment.George J. Agich - 1987 - Journal of Medicine and Philosophy 12 (2):123-144.
    In this paper I analyze the alleged conflict between economic incentives to efficiently utilize health care resources and the obligation to provide patients with the best possible medical care. My analysis is developed in four stages. First, I discuss briefly the nature of prospective payment systems and economic incentives as well as the issue of professional autonomy. Second, I disscuss the notion of an incentive for action both as an economic incentive and as a concept of moral psychology. Third, I (...)
  10. Conflicts of Interest and Management in Managed Care.George J. Agich & Heidi Forster - 2000 - Cambridge Quarterly of Healthcare Ethics 9 (2):189-204.
    The bioethics literature on managed care has devoted significant attention to a broad range of conflicts that managed care is perceived to have introduced into the practice of medicine. In the first part of this paper we discuss three kinds of conflict of interest: conflicts of economic incentives, conflicts with patient and physician autonomy, and conflicts with the fiduciary character of the physician–patient relationship. We argue that the conflicts are either not as serious as they are often alleged to be (...)
  11. Fresh Starts for Poor Health Choices: Should We Provide Them and Who Should Pay?Andreas Albertsen - 2016 - Public Health Ethics 9 (1):55-64.
    Should we grant a fresh start to those who come to regret their past lifestyle choices? A negative response to this question can be located in the luck egalitarian literature. As a responsibility-sensitive theory of justice, luck egalitarianism considers it just that people’s relative positions reflect their past choices, including those they regret. In a recent article, Vansteenkiste, Devooght and Schokkaert argue against the luck egalitarian view, maintaining instead that those who regret their past choices in health are disadvantaged in (...)
  12. Threshold Considerations in Fair Allocation of Health Resources: Justice Beyond Scarcity.Allen Andrew A. Alvarez - 2007 - Bioethics 21 (8):426–438.
  13. QALYS and the Integration of Claims in Health Care Rationing.Paul Anand - 1999 - Health Care Analysis 7 (3):239-253.
    The paper argues against the polarisation of the health economics literature into pro- and anti-QALY camps. In particular, we suggest that a crucial distinction should be made between the QALY measure as a metric of health, and QALY maximisation as an applied social choice rule. We argue against the rule but for the measure and that the appropriate conceptualisation of health-care rationing decisions should see the main task as the integration of competing and possibly incommensurable normative claim types. We identify (...)
  14. Quantifying Quality of Life for Economic Analysis: Time Out for Time Trade Off.T. M. Arnesen - 2003 - Medical Humanities 29 (2):81-86.
    The “Time trade-off” (TTO), is the most widely used method to “quality adjust” life years for “QALYs” in cost utility analysis. In this paper we ask if it is theoretically likely that the TTO is valid for this use. The TTO consists in a trade off between longevity and quality of life. Firstly, we argue that it is impossible to control for all factors that may influence one’s willingness to sacrifice lifetime. Secondly, that longevity and quality of life are too (...)
  15. Who Should We Treat? Rights, Rationing and Resources in the NHS. [REVIEW]R. E. Ashcroft - 2007 - Journal of Medical Ethics 33 (3):185-186.
  16. Fair Rationing is Essentially Local: An Argument for Postcode Prescribing.Richard E. Ashcroft - 2006 - Health Care Analysis 14 (3):135-144.
    In this paper I argue that resource allocation in publicly funded medical systems cannot be done using a purely substantive theory of justice, but must also involve procedural justice. I argue further that procedural justice requires institutions and that these must be “local” in a specific sense which I define. The argument rests on the informational constraints on any non-market method for allocating scarce resources among competing claims of need. However, I resist the identification of this normative account of local (...)
  17. The Global Distribution of Health Care Resources.R. Attfield - 1990 - Journal of Medical Ethics 16 (3):153-156.
    The international disparities in health and health-care provision comprise the gravest problem of medical ethics. The implications are explored of three theories of justice: an expanded version of Rawlsian contractarianism, Nozick's historical account, and a consequentialism which prioritizes the satisfaction of basic needs. The second too little satisfies medical needs to be cogent. The third is found to incorporate the strengths of the others, and to uphold fair rules and practices. Like the first, it also involves obligations transcending those to (...)
  18. Human Enhancement: A New Issue in Philosophical Agenda.Marco Azevedo - 2013 - Princípios. Revista de Filosofía 20 (33):265-303.
    Since before we can remember, humanity aims to overcome its biological limitations; such a goal has certainly played a key role in the advent of technique. However, despite the benefits that technique may bring, the people who make use of it will inevitably be under risk of harm. Even though human technical wisdom consists in attaining the best result without compromising anybody’s safety, misuses are always a possibility in the horizon. Nowadays, technology can be used for more than just improving (...)
  19. Talking to Each Other About Universal Health Care: Do Values Belong in the Discussion?Mary Ann Baily - 2006 - Hastings Center Report 36 (6):4-4.
    Paul Menzel and Donald Light ("A Conservative Case for Universal Access to Health Care," Jul-Aug 2006) tell a story that is plausible. However, based on my twenty-five years of experience as a policy analyst interested in access to health care, I find it inaccurate for a number of reasons.
  20. Visibility and the Just Allocation of Health Care: A Study of Age-Rationing in the British National Health Service.Robert Baker - 1993 - Health Care Analysis 1 (2):139-150.
    The British National Health Service (BNHS) was founded, to quote Minister of Health Aneurin Bevan, to ‘universalise the best’. Over time, however, financial constraints forced the BNHS to turn to incrementalist budgeting, to rationalise care and to ask its practitioners to act as gatekeepers. Seeking a way to ration scarce tertiary care resources, BNHS gatekeepers began to use chronological age as a rationing criterion. Age-rationing became the ‘done thing’ without explicit policy directives and in a manner largely invisible to patients, (...)
  21. Public Policy and the Allocation of Scarce Medical Resources.Richard L. Barber - 1987 - Journal of Philosophy 84 (11):655-663.
  22. The Ethics of Scarce Health Resource Allocation: Towards Equity in the Uganda Health Care System.John Barugahare - unknown
    The central ideas in this work are health as a moral entitlement and equity in health. It is a discourse on distributive justice in health and takes Uganda as a case study. It describes Uganda health system especially the extent and distribution of health-related injustice brought about by severe poverty and the manner health resources are raised and allocated. This manner disproportionately adversely affects the poor's access to health services and endangers their livelihoods due to catastrophic health expenditure. This work (...)
  23. A Mandate for Regional Health Ethics Resources.M. A. Bashir Jiwani - 2004 - HEC Forum 16 (4):247-260.
  24. Choosing Among Candidates for Scarce Medical Resources.Marc D. Basson - 1979 - Journal of Medicine and Philosophy 4 (3):313-333.
  25. Allocation of Scarce Medical Resources.Michael D. Bayles - 1990 - Public Affairs Quarterly 4 (1):1-16.
  26. Universal Health Care, American Style: A Single Fund Approach to Health Care Reform.Dan E. Beauchamp - 1992 - Kennedy Institute of Ethics Journal 2 (2):125-135.
    With increasing momentum for health care reform, attention is shifting to finance reform that will provide for direct methods for controlling health care spending. This article outlines the two principal paths to direct cost control and outlines a national plan that retains our multiple sources of payment, yet also contains a powerful direct cost control technique: a single fund to finance all health care.
  27. What Setting Limits May Mean: A Feminist Critique of Daniel Callahan's "Setting Limits". [REVIEW]Nora K. Bell - 1989 - Hypatia 4 (2):169 - 178.
    In Setting Limits, Daniel Callahan advances the provocative thesis that age be a limiting factor in decisions to allocate certain kinds of health services to the elderly. However, when one looks at available data, one discovers that there are many more elderly women than there are elderly men, and these older women are poorer, more apt to live alone, and less likely to have informal social and personal supports than their male counterparts. Older women, therefore, will make the heaviest demand (...)
  28. The Scarcity of Medical Resources: Are There Rights to Health Care?Nora K. Bell - 1979 - Journal of Medicine and Philosophy 4 (2):158-169.
  29. Ethical Considerations in the Allocation of Scarce Medical Resources.Nora Kizer Bell - 1978 - Dissertation, The University of North Carolina at Chapel Hill
  30. Equity and Resource Allocation in Health Care: Dialogue Between Islam and Christianity.Christoph Benn & Adnan A. Hyder - 2002 - Medicine, Health Care and Philosophy 5 (2):181-189.
    Inequities in health and health care are one of the greatest challenges facing the international community today. This problem raises serious questions for health care planners, politicians and ethicists alike. The major world religions can play an important role in this discussion. Therefore, interreligious dialogue on this topic between ethicists and health care professionals is of increasing relevance and urgency. This article gives an overview on the positions of Islam and Christianity on equity and the distribution of resources in health (...)
  31. Palliative Care, Public Health and Justice: Setting Priorities in Resource Poor Countries.Craig Blinderman - 2009 - Developing World Bioethics 9 (3):105-110.
    Many countries have not considered palliative care a public health problem. With limited resources, disease-oriented therapies and prevention measures take priority. In this paper, I intend to describe the moral framework for considering palliative care as a public health priority in resource-poor countries. A distributive theory of justice for health care should consider integrative palliative care as morally required as it contributes to improving normal functioning and preserving opportunities for the individual. For patients requiring terminal care , we are guided (...)
  32. Commentary: The Ethics of Resource Allocation.K. M. Boyd - 1983 - Journal of Medical Ethics 9 (1):25-27.
    This commentary focuses on two moral values implied by the case study but not specified in the working party's conclusions, namely equitable treatment of the most vulnerable and the value of political government.
  33. Priorities in the Allocation of Scarce Resources.K. M. Boyd & B. T. Potter - 1986 - Journal of Medical Ethics 12 (4):197-200.
    The authors report and comment on student reactions to a clinical example of moral choice in the microallocation of scarce resources. Four patients require dialysis simultaneously, but only one kidney machine is available. What moral, as opposed to clinical, criteria are available to determine who should have priority?
  34. How Should We Think About Resource Allocation?Bob Brecher - 1996 - Health Care Analysis 4 (1):37-40.
    What is immediately striking about the general problem of how to allocate resources equitably is that although the task cannot be done, it nevertheless requires to be done. Imperfection is the most we can hope for. But of course some instances of imperfection are considerably worse than others: and those evidenced in all too much of the thinking of medical specialists, whether in the current discussion concerning cancer care or, for instance, by those involved in the management of kidney transplants (...)
  35. Cost-Effectiveness and Disability Discrimination – Addendum.D. Brock - 2011 - Economics and Philosophy 27 (1):97-98.
    In my article above, I cite an earlier article by Frances Kamm, ???Deciding Whom to Help, Health-Adjusted Life Years, and Disabilities???, in Public Health, Ethics, and Equity , eds. S. Anand, F. Peters, and A. Sen circulated as a working paper of the Center for Population Studies, Harvard University). However, I failed to correctly identify her position on one view that she took up in that article, and also failed to cite a proposal she developed in that article similar to (...)
  36. Ethical Issues in the Use of Cost Effectiveness Analysis for the Prioritization of Health Care Resources.Dan Brock - 2006 - In Sudhir Anand, Fabienne Peter & Amartya Sen (eds.), Public Health, Ethics, and Equity. Oxford University Press.
  37. Priority to the Worse Off in Health Care Resource Prioritization.Dan Brock - 2002 - In Margaret Battin (ed.), Medicine and Social Justice. Oxford University Press. pp. 373-389.
    This chapter examines whether an individual’s being worse off than others should be a relevant consideration in the allocation of limited medical resources. It reviews arguments pressed by proponents of different theories of justice about whether being worse off than others makes special demands on health care resource prioritization. Even if there is good reason to restrict the concern for the worse off to those with worse health in the prioritization and allocation of health care resources, additional issues remain. One (...)
  38. Ethical Issues in the Construction of Cost-Effectiveness Analyses for the Prioritization and Rationing of Healthcare.Dan W. Brock - 1999 - The Proceedings of the Twentieth World Congress of Philosophy 1:215-229.
    The dominant methodology in health policy for prioritizing and rationing health care resources is cost-effectiveness analysis, typically using quality adjusted life years (QALYs) or disability adjusted life years (DALYs) to measure health outcomes. The construction of these measures involves a number of moral or value choices, including: How should states of health and disability be evaluated, and whose preferences (e.g., the disabled or non-disabled) should be used? How should these evaluations reflect that prioritization will involve tradeoffs between health benefits for (...)
  39. Justice and the Severely Demented Elderly.Dan W. Brock - 1988 - Journal of Medicine and Philosophy 13 (1):73-99.
    In this paper I address the relation between just claims to health care and severe cognitive impairment from dementia. Two general approaches to justice in allocation of health care are distinguished – prudential allocation and interpersonal distribution. First, I analyze why a patient who has died has no further claims to health care. Second, I show why prudential allocators would not provide for health care treatment should they be in a persistent vegetative state. Third, I argue that the destruction of (...)
  40. Justice and Competitive Markets.Baruch A. Brody - 1987 - Journal of Medicine and Philosophy 12 (1):37-50.
    This essay challenges the view that the provision of health care must take place within a competitive-free system. The author argues that, presuming that there is a requirement to meet the demands of those who cannot pay for health care, a competitive market provides a good way to deal with injustices within the health care system. The author concludes that the demands for justice are best met when indigent individuals use some portion of the funds they receive from the government (...)
  41. Good, Fairness and QALYs.John Broome - 1988 - Royal Institute of Philosophy Lectures 23 (1):57-73.
    Counting QALYs has been proposed as a way of deciding how resources should be distributed in the health service: put resources where they will produce the most QALYs. This proposal has encountered strong opposition. There has been a disagreement between some economists favouring QALYs and some philosophers opposing them. But the argument has, I think, mostly been at cross-purposes. Those in favour of QALYs point out what they can do, and those against point out what they can't. There need be (...)
  42. Allocating Scarce Medical Resources. [REVIEW]Margherita Brusa - 2004 - Theoretical Medicine and Bioethics 25 (3):215-217.
  43. Public Health Ethics: Resource Allocation and the Ethics of Legitimacy.Kristine Bærøe - 2013 - Journal of Clinical Research and Bioethics 4 (1).
    Public health ethics is a relatively new academic field. Crucially, it is distinguished from traditional medical ethics by its focus on populations rather than individuals. Still, the ethics of public health cannot be perceived completely detached from the ethics of individuals, as populations are made up of individuals. One issue that clearly falls within the intersection of a population- and an individual based perspective on ethics is resource allocation. Resource allocation takes place at various stages within the organisation of healthcare, (...)
  44. Allocating Health Resources. [REVIEW]Daniel Callahan - 1988 - Hastings Center Report 18 (2):14-20.
  45. The Ethics of Allocation of Scarce Health Care Resources.K. C. Calman - 1994 - Journal of Medical Ethics 20 (2):71-74.
    Resource allocation is a central part of the decision-making process in any health care system. Resources have always been finite, thus the ethical issues raised are not new. The debate is now more open, and there is greater public awareness of the issues. It is increasingly recognised that it is the technology which determines resources. The ethical issues involved are often conflicting and relate to issues of individual rights and community benefits. One central feature of resource allocation is the basing (...)
  46. The Complicated Relationship of Disability and Well-Being.Stephen M. Campbell & Joseph A. Stramondo - 2017 - Kennedy Institute of Ethics Journal 27 (2):151-184.
    It is widely assumed that disability is typically a bad thing for those who are disabled. Our purpose in this essay is to critique this view and defend a more nuanced picture of the relationship between disability and well-being. We first examine four interpretations of the above view and argue that it is false on each interpretation. We then ask whether disability is thereby a neutral trait. Our view is that most disabilities are neutral in one sense, though we cannot (...)
  47. Competing Principles for Allocating Health Care Resources.Drew Carter, Jason Gordon & Amber M. Watt - 2016 - Journal of Medicine and Philosophy 41 (5):558-583.
    We clarify options for conceptualizing equity, or what we refer to as justice, in resource allocation. We do this by systematically differentiating, expounding, and then illustrating eight different substantive principles of justice. In doing this, we compare different meanings that can be attributed to “need” and “the capacity to benefit”. Our comparison is sharpened by two analytical tools. First, quantification helps to clarify the divergent consequences of allocations commended by competing principles. Second, a diagrammatic approach developed by economists Culyer and (...)
  48. Equality of Resources and Procreative Justice.Paula Casal & Andrew Williams - 2004 - In Ronald Dworkin & Justine Burley (eds.), Dworkin and His Critics: With Replies by Dworkin. Blackwell. pp. 150--169.
  49. Practising Doctors, Resource Allocation and Ethics.A. D. B. Chant - 1989 - Journal of Applied Philosophy 6 (1):71-76.
    In order to slow down the inexorable increase in spending on health care, the British government has implemented an initiative proposed by Griffiths. This initiative is designed to make doctors more accountable for the decisions they may take. In this essay I argue first, that the conflation of two decisions (financial and clinical) leads to unnecessary ethical dilemmas and secondly, that as psychologically it is difficult to take two decisions simultaneously, inevitably the clinician is forced to name either the financial (...)
  50. Can It Be Ethical to Apply Limited Resources in Low-Income Countries to Ineffective, Low-Reach Smoking Cessation Strategies? A Reply to Bitton and Eyal.S. Chapman & R. Mackenzie - 2012 - Public Health Ethics 5 (1):29-37.
    Bitton and Eyal's lengthy critique of our article on unassisted cessation was premised on several straw-man arguments. These are corrected in our reply. It also confused the key concepts of efficacy and effectiveness in assessing the impact of cessation interventions and policies in real-world settings; ignored any consideration of reach (cost, consumer acceptability and accessibility) and failed to consider that clinical cessation interventions which fail more than they succeed also may ‘harm’ smokers by reducing agency. Our article addresses each of (...)
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