• Georg Marckmann.
• Institut für Ethik und Geschichte der Medizin, Universität Tübingen, Tübingen, BRD. georg.marckmann@uni-tuebingen.de
• Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2008 Aug 1;51(8):887-94.

AbstractThe paper discusses issues of justice related to health and illness. The special normative status of health is justified based on Norman Daniels' theory of just health. As the health status of individuals is not only determined by access to health care services, the relationship between social inequalities and health status is described empirically and evaluated from an ethical perspective. There are good ethical and conomical reasons against a purely market driven organization of the health care system. As a result we have to answer the question how we can deal with the increasing scarcity of health care resources. Three strategies are presented and ethically evaluated: (1) Increase efficiency ("rationalization"), (2) increase available resources and (3) limit access to services ("rationing"). Especially the pros and cons of implicit vs. explicit ways to limit services are discussed. Finally, the procedural and material ethical criteria for the just distribution of scarce health care resources are presented.

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