[Prioritizing and righteousness--what do we do when we can't do everything?].

Abstract

This article considers the principles for allocating scarce resources in the health care sector. The author discusses the conflict between the utilitarian principle of welfare maximization and the norm of equality. It is argued that the goal of equal health may lead to the problem of "the bottomless pit". That is to say, an unreasonable amount of the total health care resources will be distributed to those with the most severe conditions. The utilitarian principle leads to a more efficient distribution of resources, but in some important cases may conflict with the concern for equality or the concern for those who are worst off. The problem seems to be that the norm of distributive efficiency and the norm of distributive equality are both relevant in society. John Broome's account of fairness as equal proportional satisfaction of legitimate claims is presented as an interesting approach to this problem. A classification of criteria is also presented as a general framework for a debate on the making of priorities in the clinical setting.