ABSTRACT
The chapter analyzes the difficulties involved in selecting allocation criteria in situations where there are not enough healthcare resources for everyone who might need them. Looking at the “tragic choices” that institutions are forced to make raises questions about conceptions of justice, how they are addressed by the actors involved in healthcare systems and how they are communicated. The dilemmas that all this entails are more frequent than might be thought, and reconstructing their characteristics and conditions can help in gaining a clearer understanding of the reasons behind them, the outcomes they can produce and the difficulties in representing them publicly. In addition, clarifying these aspects can relieve at least some of the tensions that arise from the contrast between different and at times antithetical ideas of how healthcare systems should operate and what their priorities should be and thus avoid putting frontline clinicians in a position where they are burdened with the entire responsibility for making allocation decisions and justifying them to patients and the public.
