In defence of our model for just healthcare systems

Why an explicit philosophy is needed in addition to the law, and how Scanlon helps derive just policies

Bibliographic Data

ID21515068
AuthorsCaitríona Cox (0000-0001-9416-9509, The Healthcare Improvement Studies (THIS) Institute, University of Cambridge School of Clinical Medicine, Cambridge, UK, corresponding author), Zoe Fritz (0000-0001-9403-409X, The Healthcare Improvement Studies (THIS) Institute, University of Cambridge School of Clinical Medicine, Cambridge, UK)
Year2022
Volume48
Issue6
Pages416-418
Publication date2022-06-01
Open AccessNo
TypeARTICLE
VenueJournal of Medical Ethics (JOURNAL)
Journal identifiersISSN: 0306-6800 • E-ISSN: 1473-4257
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/medethics-2021-107633
PMID34497142
OpenAlexW3196558858
LanguageEN
References cited12

In a recent response to our paper on developing a philosophical framework to guide the design and delivery of a just health service, Sarela raises several objections. We feel that although Sarela makes points which are worthy of discussion, his critique does not undermine either the need for, or the worth of, our proposed model. First, the law does not negate the need for ethics in determining just healthcare policy. Reliance on legal processes can drive inappropriate focus on ensuring policies avoid judicial review, as opposed to ensuring they are truly just; the law affords protection against unjust policies but does not put a commitment to avoiding them at the heart of policy-making. We defend the need for Scanlonian supplementation by emphasising the practical value of adding a step based on reasonable rejection, particularly in ensuring that the views of vulnerable stakeholders are robustly considered. We discuss the similarities and differences between the work of Daniels and Sen in considering the relationship between health and opportunity, concluding that Sen’s capability approach is both valuable and compatible with our proposed model. Finally, the practical use of our model requires consideration of what constitutes a reasonable person. Our model is explicitly intended to help develop a healthcare system which is just to all its users. With this in mind, we suggest that those involved in decision-making should meet Scanlon’s definition of reasonable: they should be motivated to justify their actions to, and seek agreement with, others

Economics · Health care · Law and economics · Management science · Political science · Sociology · Computer Science · Ethics in medical practice · Healthcare cost, quality, practices · Law · Palliative Care and End-of-Life Issues

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