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Legitimate Allocation of Public Healthcare: Beyond Accountability for Reasonableness

Legitimate Allocation of Public Healthcare: Beyond Accountability for Reasonableness Citizens consent to political decisions is often regarded as a necessary condition of political legitimacy. Consequently, legitimate allocation of healthcare has seemed almost unattainable in contemporary pluralistic societies. The problem is that citizens do not agree on any single principle governing priorities among groups of patients. The Accountability for Reasonableness (A4R) framework suggests an ingenious solution to this problem of moral disagreement. Rather than advocating any substantive distributive principle, its advocates propose a feasible set of conditions, which, if met by decision makers at the institutional level, provide, so it is promised, legitimate decisions. While we agree that A4R represents an important contribution to the priority-setting debate, we challenge the framework in two respects. First, we argue that A4R, and more specifically the relevance condition of A4R, does not enable healthcare institutions to generally distinguish between relevant and irrelevant reasons for priority-setting. Second, we criticize Daniels and Sabin's argument that A4R and deliberative democracy constitute necessary and sufficient conditions of a feasible procedure for setting legitimate limits within healthcare. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Public Health Ethics Oxford University Press

Legitimate Allocation of Public Healthcare: Beyond Accountability for Reasonableness

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References (11)

Publisher
Oxford University Press
Copyright
The Author 2009. Published by Oxford University Press. Available online at www.phe.oxfordjournals.org
Subject
Original Article
ISSN
1754-9973
eISSN
1754-9981
DOI
10.1093/phe/php001
Publisher site
See Article on Publisher Site

Abstract

Citizens consent to political decisions is often regarded as a necessary condition of political legitimacy. Consequently, legitimate allocation of healthcare has seemed almost unattainable in contemporary pluralistic societies. The problem is that citizens do not agree on any single principle governing priorities among groups of patients. The Accountability for Reasonableness (A4R) framework suggests an ingenious solution to this problem of moral disagreement. Rather than advocating any substantive distributive principle, its advocates propose a feasible set of conditions, which, if met by decision makers at the institutional level, provide, so it is promised, legitimate decisions. While we agree that A4R represents an important contribution to the priority-setting debate, we challenge the framework in two respects. First, we argue that A4R, and more specifically the relevance condition of A4R, does not enable healthcare institutions to generally distinguish between relevant and irrelevant reasons for priority-setting. Second, we criticize Daniels and Sabin's argument that A4R and deliberative democracy constitute necessary and sufficient conditions of a feasible procedure for setting legitimate limits within healthcare.

Journal

Public Health Ethics – Oxford University Press

Published: Apr 5, 2009

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