3 - Necessity of Health Care Rationing

Question 1

what is the main argument in Sreenivasan’s paper “why justice requires rationing in healthcare”?

Answer 1

Sreenivasan explores the idea that healthcare rationing is not only a necessity due to limited resources but also a requirement of justice

Question 2

what is the connection between rationing and justice (sreenivasan)?

Answer 2

Because resources are finite, rationing is an unavoidable reality. Every healthcare system, regardless of its wealth, must make decisions about how to allocate its limited resources.

Rationing in healthcare is not just a matter of economic necessity but also a requirement of justice.
Sreenivasan asserts that just because resources are limited, it does not imply that any method of rationing will be just. Instead, he emphasizes that the methods and criteria used in rationing decisions must be fair and equitable.

Question 3

Which frameworks does Sreenivasan explore as criterias for just rationing?

Answer 3

Utilitarianism, egalitarianism, and prioritarianism

Question 4

What does Sreenivasan argue the role of cost-effectiveness is?

Answer 4

He suggests that it is an important consideration in ensuring that healthcare resources do the most good. However, he cautions against allowing cost-effectiveness to be the sole criterion, advocating for its use in conjunction with other ethical principles.

Question 5

what is a fundamental issue in health care allocation?

Answer 5

scarcity of resources, and how to use them the most effectively and justly

Question 6

what is Bognar and Hirose’s main arguments about the ethics of healthcare?

Answer 6

• Health care rationing is the controlled allocation of health care resources, which is ubiquitous and inevitable
• Health care rationing is an ethical issue, and it needs to be governed by ethical principles.
• Two relevant, basic moral ideas are the maximization of the benefits from the use of health care resources and the fairness of the distribution of those benefits.

Question 7

what is the concept of health?

Answer 7

· Concept of health changes over time - socially constructed images
· Based on philosophy, civil rights, social movements, scientific and medical research

Question 8

What are different ways to finance and deliver healthcare?

Answer 8

Finance:
- health insurance (public/private)
- government funding
- co-payment

Delivery:
- public
- private

Question 9

What is the reverse-engineered approach?

(srinivasan)

Answer 9

“According to the reverse-engineered approach, we should first decide which health care services the national health care system should include, and then calculate the national health care budget derivatively, by simply reading it off the aggregate cost (in a given year) of the services we have already decided to include”

Question 10

what is the rationing approach?

Answer 10

we should first specify the percentage of GDP to be spent on health care, and only afterwards decide which health care services to finance out of that (provisionally) fixed budget

Question 11

Why is Srinivasan sceptical of the reverse engineering appraoch for healthcare rationing?

Answer 11

the reverse-engineered approach answers these questions in the wrong order, and we should approach it in the order of the rationing approach

Question 12

what are srinivasan’s 3 premises on rationing healthcare?

Answer 12

1. health is not the only good with an important claim on social expenditures
2. The limit on justifiable health care spending is independent of the aggregate cost of the medically necessary services required by a given population (in a given year), at least for any strictly scientific definition of “medically necessary.”
3. the rate of growth in potential spending on medically necessary health care services exceeds the rate of growth in GDP

Question 13

What is the Preson hypothesis?

Answer 13

Strong correlation between health and wealth up to a certain point, but then after a certain point the correlation is very weak

Question 14

what is a duty?

Answer 14

A duty is an obligation or requirement to act in a certain way. It defines what individuals ought to do based on moral rules or principles

Question 15

what is a moral imperative?

Answer 15

These are categorical commands that dictate actions one must perform or avoid, regardless of the expected outcomes

Question 16

what is a right?

Answer 16

Rights are entitlements that individuals possess, and respecting these rights is often considered a moral duty.

Question 17

what are prohibitions?

Answer 17

Prohibitions specify actions that are morally forbidden, regardless of the potential benefits.

Question 18

what are permissions?

Answer 18

Permissions indicate actions that are morally permissible or allowed but not necessarily required.

Question 19

what is value?

Answer 19

Value refers to the worth or importance of something. It can be intrinsic (valuable in and of itself) or instrumental (valuable for achieving some other end).

Question 20

what is goodness?

Answer 20

Quality of being morally right or virtuous, often associated with actions, character traits, or outcomes that promote well-being or fulfill a moral ideal.

Question 21

what is virtue ethics?

Answer 21

Virtue ethics is a moral theory that emphasizes the development of virtuous character traits as the foundation of ethical behavior.

Question 22

what is utility?

Answer 22

Utility refers to the usefulness or happiness that a particular action or decision brings about. Utilitarianism is an ethical theory that prioritizes actions that maximize overall utility

Question 23

define consequentialism

Answer 23

A prominent ethical theory in moral philosophy that evaluates the morality of actions based on their outcomes or consequences. In other words, an action is considered morally right if it leads to the best possible outcome.

Question 24

define deontology

Answer 24

An ethical theory in moral philosophy that emphasizes the importance of moral principles, duties, and rules as the foundation for determining the morality of actions. Focuses on the inherent rightness or wrongness of actions themselves, regardless of the consequences they produce. Deontic concepts depend on axiological concepts.

Question 25

what is the WHO definition of health?

Answer 25

“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.”

Question 26

what are sreenivasan main claims?

Answer 26

• Very poor states do not bear the moral duties correlative to human claim-rights to health.
• There is a problem of global distributive justice, but not the human right to health.
• The human right to health against the state requires too much.

Question 27

What are Hausman’s main arguments?

Answer 27

• The human right to minimally good life
• The human right to the minimal level of health

Question 28

what is the difference between a positive and a negative right?

Answer 28

negative right - freedom from smt, ie from arbitrary arrest

positive right - freedom to do smt, ie freedom of speech

Question 29

What are the three criterias for something to be defined as a human right?

Answer 29

universality, enforceability, and justiciability

Question 30

What arguments do Hausman put forward to see healthcare as a human right?

Answer 30

Hausman reviews the arguments in favor of considering healthcare as a human right. These arguments often hinge on the ideas of justice, equity, and the moral imperative to alleviate suffering and promote well-being. Proponents argue that access to healthcare is essential for individuals to enjoy other rights and to participate fully in society.

Question 31

what are challenges to the view of healthcare as a HR?

Answer 31

• difficulties in defining what constitutes ‘essential’ healthcare and how this might vary across different societies and contexts.
• practical challenges of implementing and enforcing such a right, given the limitations of resources and the complexities of healthcare systems.

Question 32

how does Sreenivasan distinguish between right and good?

Answer 32

He argues that while health is undoubtedly a good, it does not automatically qualify as a right. He suggests that not all desirable or necessary goods should be construed as rights, particularly when their realization depends on extensive social resources and coordination.

Question 33

what is the main distinction put forward by sreenivasan between right to health and right to healthcare

Answer 33

Sreenivasan distinguishes between the right to health care and the right to health. He is more sympathetic to the idea of a right to health care, which focuses on access to services, rather than a right to health, which implies a state of well-being. He argues that the former is more practical and easier to define and implement.