HEC Forum 33 (4):345-370 (2021)

Steven R. Kraaijeveld
Wageningen University and Research
Type 1 diabetes (T1D) is a chronic illness that requires intensive lifelong management of blood glucose concentrations by means of external insulin administration. There have been substantial developments in the ways of measuring glucose levels, which is crucial to T1D self-management. Recently, continuous glucose monitoring (CGM) has allowed people with T1D to keep track of their blood glucose levels in near real-time. These devices have alarms that warn users about potentially dangerous blood glucose trends, which can often be shared with ther people. CGM is consistently associated with improved glycemic control and reduced hypoglycemia and is currently recommended by doctors. However, due to the costs of CGM, only those who qualify for hospital provision or those who can personally afford it are able to use it, which excludes many people. In this paper, I argue that unequal access to CGM results in: (1) unjust health inequalities, (2) relational injustice, (3) injustice with regard to agency and autonomy, and (4) epistemic injustice. These considerations provide prima facie moral reasons why all people with T1D should have access to CGM technology. I discuss the specific case of CGM policy in the Netherlands, which currently only provides coverage for a small group of people with T1D, and argue that, especially with additional considerations of cost-effectiveness, the Dutch government ought to include CGM in basic health care insurance for all people with T1D.
Keywords type 1 diabetes  continuous glucose monitoring  justice  access to health care  health care ethics
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DOI 10.1007/s10730-020-09413-9
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References found in this work BETA

Principles of Biomedical Ethics.Tom L. Beauchamp - 1979 - Oxford University Press.
What is the Point of Equality.Elizabeth Anderson - 1999 - Ethics 109 (2):287-337.
Epistemic Injustice in Healthcare: A Philosophical Analysis.Ian James Kidd & Havi Carel - 2014 - Medicine, Health Care and Philosophy 17 (4):529-540.

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