van Willigenburg T
Faculty of Theology, Utrecht, The Netherlands.
Health Care Anal. 1993 Jun;1(1):49-52. doi: 10.1007/BF02196970.
This article accounts for the failure of the Dutch Government Committee on Choices in Health Care to develop useful criteria of necessary care by which to set health care priorities and ration resources. The Government Committee has been inspired by philosophers who think that allocation problems cannot be solved without placing broad moral questions about the good life, and about the place of health and illness in our lives on the public agenda. The fruitless attempts of the Committee to formulate an effective notion of essential care, based upon a community-oriented perspective of health, shows why the communitarian approach is bound to fail. Questions about essential health care cannot be answered on a macro-level. The only way to get some reasonable control over day-to-day health care allocation decisions in hospitals and institutions is by trying to understand the history, laws, habits and contingencies of what is going on between doctors and patients. Such an understanding can be gained by developing a relational and biographical view on the doctor-patient relationship.
本文阐述了荷兰医疗保健选择政府委员会未能制定出有用的必要医疗标准，以便据此确定医疗保健优先事项并分配资源。该政府委员会受到一些哲学家的启发，这些哲学家认为，如果不将关于美好生活以及健康与疾病在我们生活中的地位等广泛的道德问题提上公共议程，分配问题就无法解决。委员会基于以社区为导向的健康视角来制定有效必要医疗概念的无果尝试，表明了社群主义方法为何注定会失败。关于基本医疗保健的问题无法在宏观层面得到解答。对医院和机构日常医疗保健分配决策进行合理控制的唯一方法，是试图了解医患之间正在发生的事情的历史、法律、习惯和偶然情况。通过建立关于医患关系的关系性和传记性观点，可以获得这种理解。
