Churchill L, Hauerwas S, Smith H
Health Prog. 1985 Dec;66(10):32-5.
Health care in this nation is becoming multitiered--with the poor in jeopardy of being excluded from even minimal care--because of the mistaken belief that money can buy unlimited health care for everyone. But our medical resources are finite, and choices must be made on how to distribute those resources. These choices should be based on a carefully reasoned concept of distributive justice; but even more important, they should be rooted in a Christian sense of community and in the conviction that service to others is more important than life itself. At least three basic models of justice can be identified. Market justice follows the general rule, To each according to his or her ability to pay. Merit justice holds that medical care should be apportioned relative to patients' efforts to stay healthy. Needs-based justice maintains that individuals' needs should be the sole criterion for allocating health care. Developing and testing such concepts of justice is necessary, but it is not enough. As those with economic and social power increasingly capture society's medical resources to keep their own deaths at bay through costly and extraordinary forms of treatment, Christians may well be impelled to take a stand in behalf of those who are being deprived of basic care. This stand may even include forgoing extraordinary treatment for themselves and accepting the appropriateness of their own deaths. Such a witness to the world, however, must be founded in faith and in Christian belief regarding the meaning of death.
这个国家的医疗保健正在变得多层次化——穷人甚至面临被排除在最基本医疗之外的风险——因为存在一种错误观念，即金钱可以为每个人买到无限制的医疗保健。但我们的医疗资源是有限的，必须就如何分配这些资源做出选择。这些选择应该基于经过仔细推理的分配正义概念；但更重要的是，它们应该植根于基督教的社区意识以及服务他人比生命本身更重要的信念。至少可以确定三种基本的正义模式。市场正义遵循一般规则，即“根据每个人的支付能力进行分配”。功绩正义认为医疗保健应根据患者保持健康的努力程度进行分配。基于需求的正义主张个人需求应是分配医疗保健的唯一标准。发展和检验这些正义概念是必要的，但这还不够。随着拥有经济和社会权力的人越来越多地通过昂贵且特殊的治疗方式来获取社会的医疗资源以延缓自己的死亡，基督徒很可能会被迫代表那些被剥夺基本医疗的人表明立场。这种立场甚至可能包括他们自己放弃特殊治疗并接受自身死亡的适当性。然而，这种对世人的见证必须建立在信仰以及基督教对死亡意义的信念之上。
