Justice and Procedure: How does “accountability for reasonableness” result in fair limit-setting decisions?
Journal of Medical Ethics 35 (1):12-16 (2009)
Abstractorman 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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References found in this work
Limits to Health Care: Fair Procedures, Democratic Deliberation, and the Legitimacy Problem for Insurers.Norman Daniels & James Sabin - 1997 - Philosophy and Public Affairs 26 (4):303-350.
The Ends of Human Life: Medical Ethics in a Liberal Polity.Ezekiel J. Emanuel - 1991 - Harvard University Press.
Citations of this work
Ethical Dilemmas in Protecting Susceptible Subpopulations From Environmental Health Risks: Liberty, Utility, Fairness, and Accountability for Reasonableness.David B. Resnik, D. Robert MacDougall & Elise M. Smith - 2018 - American Journal of Bioethics 18 (3):29-41.
Evaluating the Capacity of Theories of Justice to Serve as a Justice Framework for International Clinical Research.Bridget Pratt, Deborah Zion & Bebe Loff - 2012 - American Journal of Bioethics 12 (11):30-41.
NICE and Fair? Health Technology Assessment Policy Under the UK’s National Institute for Health and Care Excellence, 1999–2018.Victoria Charlton - 2020 - Health Care Analysis 28 (3):193-227.
Potential for Epistemic Injustice in Evidence-Based Healthcare Policy and Guidance.Jonathan Anthony Michaels - 2021 - Journal of Medical Ethics 47 (6):417-422.
The Limited Impact of Indeterminacy for Healthcare Rationing: How Indeterminacy Problems Show the Need for a Hybrid Theory, but Nothing More.Anders Herlitz - 2016 - Journal of Medical Ethics 42 (1):22-25.
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