REVIEWED BY RICHARD M. HAUGHIAN, DTH
Anthony Fisher, OP, and Luke Gormally, eds.
The Linacre Centre for Healthcare Ethics, London, 2001.
238 pp., $22
Many of the most pressing and complex public health care policy
issues today relate to the demands for limited health care resources
to satisfy virtually limitless needs. This book, sponsored by
the Catholic Bishops of Great Britain and Ireland and prepared
by the Catholic Bishops' Joint Bioethics Committee, is written
to contribute to this important public dialogue.
The purpose of this book is to provide both an ethical critique
of prevailing approaches to health care allocation and to identify
the basic ethical framework of moral principles that should
govern the just allocation of health care resources. The authors
make it clear that this work is not a blueprint for resource
allocation. An ethical framework, although a decisive determinant
of resource allocation policy, is only one factor to be considered.
Nor do the authors believe that a uniquely correct solution
or approach to these issues exists for the United Kingdom or
for other similar economies. It is clear to them, however, that
much current thinking about resource allocation is both intellectually
and morally unsatisfactory.
The underlying assumptions and orientations of the book are
Christian and rely in particular on the Christian natural law
tradition, especially in bioethics, and Catholic social teaching.
Because the authors hope to engage in dialogue with a broad
audience of policy decisions makers, however, they have appropriately
chosen points of departure, a method of argumentation, and a
language that appeals to reason and experience. This approach
should have a wider appeal, incorporating what the authors refer
to as the best of our "common morality" of principles such as
are articulated in the Bible and the Koran, the Hippocratic
Oath, contemporary "virtue ethics," the common law, international
human rights documents, and the teachings of many thinkers,
both secular and religious.
Because the context of this book is resource allocation in
the United Kingdom, particular reference is made to the "crisis"
in the National Health Service (NHS) and to the increasing number
of complaints about equity, comprehensiveness of access, failures
of care, and other concerns. Similar "crises" are also being
faced in other developed countries, and because the approach
is essentially at the level of values and principles, this book
can be readily applied in countries other than the United Kingdom,
such as the United States and Canada.
Healthcare Allocation is tightly organized and clearly
presented; its argument is systematic and nuanced. Summaries
at the beginning of each chapter and a concluding summary of
the book's line of argument make for easy reference. Beginning
with a preliminary clarification of key terms and issues in
the allocation debate, the book presents a critique of contemporary
approaches to allocation; argues for a justice framework built
on an understanding of the human good, persons and their needs,
the common good, distributive justice, and the nature of human
community; and critiques the inadequacies of the criteria frequently
proposed in this debate. It addresses many of the most hotly
debated allocation issues, such as the needs of those at risk — the
frail elderly, the handicapped, the mentally ill, and the poor — as
well as the need to respect basic human rights, punitive and
prejudiced health care allocations, and competing social goals.
There is a chapter summarizing Catholic social teaching related
to the allocation of health care resources, and brief considerations
of other commonly raised issues, such as how much should be
spent on health care, health care as a right, the public/private
mix, who should be the gatekeepers, and the need for public
debate on these issues.
True to its title and intent, this book serves well as a framework
of principles for treating the many issues and points of view
currently under discussion. It gives an excellent critique of
current approaches to resource allocation, such as, "ad hocery,"
the free market, and the liberal-welfarist and the utilitarian-economic
views. These approaches are found to be inadequate in their
understanding of the human good, the needs of the human person,
the community and the common good, and health care itself.
The justice perspective emphasized throughout the book is
one of its strengths. A just health care service would ensure
access for all members of the community to care sufficient to
meet their health care needs. Health care services should be
allocated according to need, irrespective of factors such as
age, race, sex, religion, social contribution, consciousness,
intelligence, quality of life, provider whim, and ability to
pay; however, preference should be given to those who are disadvantaged.
At several points, the book reflects on the Gospel parable of
the Good Samaritan as a useful model for good practice in health
care allocation. The chapter on Catholic social and bioethical
teaching and health care allocation is an excellent summary
of this teaching and provides a valuable reference for anyone
wishing to understand the specific contribution of Catholic
thinking in this area.
Because the book presents an ethical framework of general
principles, it does not develop in detail the many issues it
raises. However, it presents a coherent justice perspective
that can be a valuable asset for any health care providers or
decision makers who are struggling with these resource allocation
Richard M. Haughian, DTH
Catholic Health Association of Canada
Copyright © 2002 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.