Journal of Medical Ethics 45 (1):75-76 (2019)

Gabriele Badano
University of York
William Smith’s recent article criticises the so-called orthodox approaches to the normative analysis of healthcare resource allocation, associated to the requirement that decision-makers should abide by strictly procedural principles of legitimacy defining a deliberative democratic process. Much of the appeal of Smith’s argument goes down to his awareness of real-world processes and, in particular, to the large gap he identifies between well-led democratic deliberation and the messiness of the process through which the intuitively legitimate Affordable Care Act was created. This reply aims to demonstrate that the ACA provides no counterexample to orthodox views, seizing this opportunity to explore the specific space that the procedural principles populating orthodox accounts are meant to regulate. Neither general questions of healthcare justice concerning, for example, universal access nor, relatedly, the activity of elected politicians falls within the natural scope of application of such principles, revealing a much more complex picture of the interactions between justice and legitimacy as well as substantive and procedural considerations than acknowledged by Smith. In the end, orthodox accounts of healthcare resource allocation turn out to provide a precious fund of theoretical resources for the normative study of administrators, which might be useful well beyond bioethics and health policy.
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DOI 10.1136/medethics-2018-104932
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References found in this work BETA

Legitimacy in Bioethics: Challenging the Orthodoxy.William R. Smith - 2018 - Journal of Medical Ethics 44 (6):416-423.
The Social Determinants of Health, Care Ethics and Just Health Care.Daniel Engster - 2014 - Contemporary Political Theory 13 (2):149-167.
5. Just Deliberation About Health Care.Dennis Thompson & Amy Gutmann - 2004 - In Dennis Thompson & Amy Gutmann (eds.), Why Deliberative Democracy? Princeton University Press. pp. 139-159.

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Citations of this work BETA

Notes on Substantance in Orthodox Theory: A Reply to Badano.William R. Smith - 2019 - Journal of Medical Ethics 45 (4):275-276.

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