ABSTRACT
This chapter considers how society should develop publicly debated, publicly approved, and equitably applied rules for rationing that allow for exceptions. It is concerned with the prism of a case and proceed by considering the need for a public system of norms and the need for exceptions. Attention to exceptional cases, with their particular needs, is required not only in order to preserve respect for each patient, but also to preserve the arts of the various health-care professions. The importance of publicity for health-care limits was recently underscored by Paul Menzel in Strong Medicine. Coronary arterial by-pass grafting for elderly patients is often listed among the villains of high technology medicine that is not costworthy. The powerful forces that push in the direction of treating, even in the face of serious doubts about the benefits, tend to overwhelm patients, their families, and health-care professionals alike.
