Principles of justice in health care rationing

This paper compares and contrasts three different substantive (as opposed t o procedural) principles of justice for making health care priority-setting or "rationing" decisions: need principles, maximising principles and egali tarian principles. The principles are compared by tracing out their implica tions for a hypothetical rationing decision involving four identified patie nts. This decision has been the subject of an empirical study of public opi nion based on small-group discussions, which found that the public seem to support a pluralistic combination of all three hinds of rationing principle . In conclusion, it is suggested that there is room for further work by phi losophers and others on the development of a coherent al Ed pluralistic the ory of health care rationing which accords with public opinions.