JUST CARING - OREGON, HEALTH-CARE RATIONING, AND INFORMED DEMOCRATIC DELIBERATION
JUST CARING - OREGON, HEALTH-CARE RATIONING, AND INFORMED DEMOCRATIC DELIBERATION
复制标题
DOI：
10.1093/jmp/19.4.367
复制
发表时间：
1994-08-01
影响因子：
1.6
通讯作者：
FLECK, LM
中科院分区：
文献类型：
--
作者：
FLECK, LM
本文认为，我们国家在卫生改革方面的努力应该从俄勒冈州的11个关键教训中吸取教训。具体而言，我们必须认识到，医疗保健配给的必要性是不可避免的，任何配给过程都必须是公开和可见的，公平的配给协议必须通过理性的民主审议过程自我强加。本文的第一部分指出，配给是我国目前医疗保健制度的一个普遍特征，但它大多是隐性配给，这是推定不公正的。第二部分认为，卫生保健配给的必要性是不可避免的。虽然俄勒冈州作为一个健康配给的模式是有缺陷的，但它为我们在国家层面上的健康改革提供了值得借鉴的道德教训，我将在第三部分中对此进行分析和辩护。这些教训中最重要的是理性的民主审议在为社区制定公平配给协议方面的重要性。在第四部分中，我概述了这种方法的哲学理由，并回应了丹尼尔斯的一些重要批评。
This essay argues that our national efforts at health reform ought to be informed by eleven key lessons from Oregon. Specifically, we must learn that the need for health care rationing is inescapable, that any rationing process must be public and visible, and that fair rationing protocols must be self-imposed through a process of rational democratic deliberation. Part I of this essay notes that rationing is a ubiquitous feature of our health care system at present, but it is mostly hidden rationing, which is presumptively unjust. Part II argues that the need for health care rationing is inescapable. Although Oregon is flawed as a model of health rationing, it gives us worthy moral lessons for health reform at the national level, which I analyze and defend in Part III. The most significant of these lessons is the importance of rational democratic deliberation in articulating fair rationing protocols for a community. In Part IV I sketch the philosophic justification for this approach and respond to some important criticisms from Daniels.