Kennedy Institute of Ethics journal
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After establishing that it is essential that health care be rationed in some fashion, the paper examines the arguments for and against clinicians as gatekeepers. It first argues that bedside clinicians do not have the information needed to make allocation decisions. ⋯ It is argued that both groups of physicians and administrators will also make allocations incorrectly and that leaving the allocation decisions to patients themselves is the best approach. Mechanisms for fair and efficient rationing by patients at the societal and individual level are examined.
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Justice is widely thought to consist in equality. For many theorists, the central question has been: Equality of what? The author argues that the ideal of equality distorts practical reasoning and has deeply counterintuitive implications. Moreover, an alternative view of distributive justice can give a better account of what egalitarians should care about than can any of the competing ideals of equality.