ABSTRACT
This chapter distinguishes rationing limited resources from medical futility. It presents what justice includes and why it is often granted special moral weight. The chapter also reflects on how the value of life and health should impact allocation of limited health care resources. It considers some opposing views on the fairness of health care coverage for all. Medicine is increasingly making possible new but expensive life-extending interventions for which there is great demand but also limited availability. The chapter also addresses questions of fairness in the distribution of these and other health care services. Efficiency in turn requires a measurement of health benefits and costs. Among the several methods of measurement devised by health care economists is Alan Williams's (1985) quality-adjusted life years (QALYs). Distributive justice is the part of social justice concerned with what is fair in the allocation of benefits and burdens in society between individuals or groups.
