Procedural justice and democratic institutional design in health-care priority-setting
Procedural justice and democratic institutional design in health-care priority-setting
复制标题
卫生保健优先事项设定中的程序正义和民主制度设计
DOI：
10.1057/cpt.2012.28
复制
发表时间：
2013
影响因子：
1.8
通讯作者：
Claudia Landwehr
中科院分区：
文献类型：
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作者：
Claudia Landwehr
医疗保健品是具有特殊性质的商品，如果它们稀缺，社会就会面临潜在的爆炸性分配冲突。过去几十年来，公众和学术界就医疗保健限制设定的必要性和可能的正义性展开了激烈的辩论，并且最近转向了程序性正义标准，而不是实质正义标准。本文认为，丹尼尔斯和萨宾提出的对医疗保健配给中程序正义最有影响力的论述在配给机构的具体属性方面是不确定的。这些属性将实质性规范写入制度。这些规范只能从民主多数决定中获得有效性，这必须被视为纯粹程序正义的实例。因此，我们必须将讨论转移到元层面，并询问如何选择制度的具体属性。我提出了充分民主的制度设计选择的四个标准，并得出结论，由于制度属性可能会对最终的医疗保健分配产生影响，因此设计选择应该以经验为依据，并以民主和审慎的方式进行。
Health-care goods are goods with peculiar properties, and where they are scarce, societies face potentially explosive distributional conflicts. Animated public and academic debates on the necessity and possible justice of limit-setting in health care have taken place in the last decades and have recently taken a turn toward procedural rather than substantial criteria for justice. This article argues that the most influential account of procedural justice in health-care rationing, presented by Daniels and Sabin, is indeterminate where concrete properties of rationing institutions are concerned. Such properties inscribe substantial norms into institutions. These norms can derive validity only from democratic majority decisions, which must be seen as an instance of pure procedural justice. We therefore have to move the discussion to a meta-level and ask how concrete properties of institutions are being chosen. I suggest four criteria for sufficiently democratic institutional design choice and conclude that as institutional properties are likely to have effects on the resulting distribution of health care, design choices should be empirically informed and taken both democratically and deliberately.