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.

“医疗必要性”这一概念在关于(A)适当的病人护理、(B)医疗资源的公平分配和(C)关于病人对法定健康保险的索赔的社会法规定的讨论和规范制定中发挥着核心作用。Cum rano salis可以说，在这三种情况下，MED-N具有监管理念的功能，与“中间适应症”的概念大致相同。简而言之，MED-N标志着医疗保健服务的领域，患者可以根据医疗、伦理和社会法律推理合法地要求这些服务。乍一看，MED-N似乎是一个客观的医学终结点。根据这些发现，值得注意的是，医学-n的概念是出了名的模糊，对不同的解释是开放的。因此，它作为监管概念的能力可能会受到质疑。特别是，MED-N这一概念在不同的情况下似乎有不同的使用和理解。它以尚未系统理解的方式合并了规范性和描述性要素，关于隐含价值判断的类型和起源仍然含糊不清。这个项目想要弥补这些赤字。它应有助于回答以下核心问题：-概述MED-N概念的不同用途--概念的描述性和规范性要素的相互作用--MED-N一致的理想概念的似是而非--MED-N作为管理概念的实用和规范的优点和危险。通过预期的答案，我们希望标注出在病人护理中关于专业性、自主性和家长主义的实质性规范分歧的轮廓。此外，我们希望在政治和伦理方面关于适当获得护理的辩论有更大的透明度。此外，这可能会使我们(公共资助的)法定健康保险范围的法律要求的一致性和背景假设更加清晰。监管的医学-n-概念是明确的、相互统一的，还是完全放弃，转而采用“新鲜”或更精确的概念，只有在项目结束时才能回答。

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.