Rättvisa och demokrati : Om prioriteringar i sjukvården : [rationing health care resources]

Sammanfattning: The dissertation focuses on the growing problem of allocating scarce health care resources inmodem societies. There are several factors which have contributed to the aggravation of thisproblem. The most important is the success. of medical science and technology combined withthe increased longevity of the population, Two issues are raised by these concomitant developments: How should scarce health care resources be allocated? Who should have the authority to do so? These question arc analysed in terms of the core philosophical concepts of justice and democracy.Should we be held responsible for our life styles, and is age a justifiable criterion in theselective allocation of health care? These are seen as the two most important aspects when theissue of justice is addressed, particularly in view of the fact that the official Swedish standpoint is that these are not legitimate criteria in this context, whereas both ordinary citizens,politicians and health care personnel on the whole tend to think that they are. At the same time age and personal responsibility are two of the most problematic issues within the current politico-philosophical debate on justice.Three fundamental theories of justice are discussed: utilitarianism, Rawlsian rights theories and perfectionism (the latter also including communitarianism). It is shown in the study that the criteria of both age and of personal responsibility can be justified `irrespective of the theory chosen. What are the consequences of this?Even though there is no indisputable answer to the question of justice, the possibility ofreasoned argumentation remains. What is needed within this context are institutions supporting the intersubjectivity of both medical and normative discourses of knowledge. Finally, it isargued that only medical doctors can decide on the allocation of scarce health care resources.This responsibility cannot be evaded by introducing randomness to the decision-making process or otherwise rejecting the possibility of reasoned argumentation.