Medical Necessity in the Contexts of Patient Care, Health Politics, and Setting Limits to Health Services. An Analysis in Medical Philosphy, Health Ethics, and Social Law.

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The concept of "medical necessity" (med-n) is playing a central role in discussions and norm-setting regarding (a) appropriate patient care, (b) fair allocation of medical resources, and (c) social law's regulations of patients' claims against Statutory Health Insurance. Cum grano salis it can be stated that in these three contexts med-n has the function of a regulatory idea, much the same as th concept of "medial indication". In a nutshell, med-n is marking the realm of health care services that patients can legitimately claim according to medical, ethical, and socio-legal reasoning. On first sight, med-n appears as an objective medical terminus technicus. In the light of these findings it is notable, that the notion of med-n is notoriously vague and open for different interpretations. As a result its aptitude as a regulatory concept might be doubted. In particular, the notion of med-n seems to be used and understood differently in different contexts. It merges normative and descriptive elements in a not yet systematically understood manner and it remains obscure with regard to type und genesis of implicit value judgements. This project wants to remediate these deficits. It should help answering the following central questions: - outlining the different uses of the med-n-concept- the interaction of descriptive and normative elements of the concept- The plausibility of a consistent ideal concept of med-n- the pragmatic and normative advantages and dangers of med-n as regulatory concept. With the expected answers we hope to mark contours of the substantive normative disagreements over professionalism, autonomy, and paternalism in patient care. Moreover, we expect greater transparency for debates in politics and ethical about appropriate access to care. Also, it might lead to greater clarity about consistency and background assumptions of legal requirements for the scope of our (publically financed) Statutory Health Insurance. Whether the regulatory med-n-concept is to be specified, intercontextually unified or altogether given up in favor of "fresh" or more precise concepts can only be answered at the end of the project.