ThoughtsJust caring: Do we need philosophical foundations?Prendre soin : avons-nous besoin d’une réflexion philosophique ?
Section snippets
The challenges of health care rationing in the real world
Let me sketch out several illustrative problems of health care justice, followed by a quick analysis intended to show the limitations of theories of health care justice. Many readers will be familiar with these extraordinarily expensive cancer drugs often referred to as “targeted therapies” that comprise what is called “precision medicine”. In the United States these drugs have costs for a course of treatment that range from $100,000 to $200,000. And, in some circumstances, these drugs are used
Health care justice and rational democratic deliberation
Norman Daniels has articulated what he refers to as “the democracy problem” [26]. It is a challenge to advocates for the role of rational democratic deliberation in addressing justly the problem of health care rationing. If the deliberative process is supposed to yield just outcomes, how do we know that the outcomes are really just? How do we know that the deliberative process might not have resulted in a mistake? Surely that is a reasonable concern. However, if we in fact can assess the
Philosophers, foundations, and democratic deliberation
The question that provoked this essay was the question of whether our conception of health care justice required a philosophic foundation of some sort. I argue that it does not. The problem with foundations is that they are solid, inflexible, immoveable, and unresponsive. Philosophic theories of justice may have a bit more flexibility but they often reflect a narrow ideological view. When it comes to the problems of health care justice in a rapidly changing and complex health care environment,
Disclosure of interest
The author declares that he has no competing interest.
References (29)
A theory of justice
(1971)Anarchy, state, and utopia
(1974)Political liberalism
(1993)- et al.
Combined nivolumab and ipilimumab or monotherapy in untreated melanoma
N Engl J Med
(2015) Treating with checkpoint inhibitors – figure $1 million per patient
Am Health Drug Benefits
(2015)- et al.
Intratumor heterogeneity and branched evolution revealed by multiregion sequencing
N Engl J Med
(2012) - et al.
Value-based care in lung cancer
Oncologist
(2016) - et al.
Unintended consequences of expensive cancer therapeutics – the pursuit of marginal indications and a me-too mentality that stifles innovation and creativity: the John Conley Lecture
JAMA Otolaryngol Head Neck Surg
(2014) The value of life: an introduction to medical ethics
(1985)Health, luck, and justice
(2010)
Solidarity and justice in health care: a critical analysis of their relationship
Diametros
Just caring: the insufficiency of the sufficiency principle in health care
Efficacy and safety of evolocumab in reducing lipids and cardiovascular events
N Engl J Med
Efficacy and safety of alirocumab in reducing lipids and cardiovascular events
N Engl J Med
Cited by (0)
- 1
Nozick is a libertarian. For him individuals have a just claim only to that which they have justly acquired, mostly by paying for it. But even in the United States few would argue that a hospital would have acted justly if it dumped a patient in the hospital parking lot to die because they could not pay for the medical care that would have saved their life. Rawls is at the opposite end of the justice spectrum from Nozick. Rawls is especially concerned to protect the just interests of those who are least well off, in this case the medically least well off. Again, however, few would argue that a just society was ethically obligated to spend a million dollars to sustain someone terminally ill for two extra weeks of life. In both cases, more ethically nuanced judgments are required.