ABSTRACT
Far more than perhaps anyone would be comfortable admitting, decisions about who will live and who will die are made in terms of a balance of benefit and cost. In a social environment where scarcity of resources is a given, it would be morally unacceptable for anyone to demand an unending stream of health care resources, irrespective of the benefits he or she received. Even a rough sense of justice insists that it is a waste to use scarce resources on one person when no benefit accrues. On the other hand, the same rough sense of justice insists that the demand for a minimal set of resources when the potential benefits are enormous – say life itself – should always be met, whoever the beneficiary and whatever the circumstances. Between those extremes, however, our sense of justice is less clear.
