ABSTRACT
Every health system reflects a series of ethical assumptions. Consciously or unconsciously, explicitly or implicitly, these assumptions are expressed in the distribution of healthcare benefits and in the organisation of institutions. Before articulating its specific technical proposals, every attem pt to reform the health system m ust begin by asking which values it should prom ote.1 In this way, the ethical foundations of reform proposals would be made clear and transparent.2 3 Such a definition at the systemic level will constrain the ethical choices available at the level of specific organisations charged w ith financing, providing or managing health services.
