Nilstun T
Department of Medical Ethics, Lund University, Stora Gråbrödersgatan 16, SE-22222 Lund, Sweden.
Croat Med J. 2000 Dec;41(4):375-7.
In this paper, priority setting in health care is defined as distributional decisions at the individual level involving clear and direct limitation of access to beneficial health care according to some categorical criterion other than the market. The justification of a particular rule of priority setting depends on conceptual issues as well as on the choice of value premises. Especially important is the type of scarcity involved (whether the imbalance between supply and need can be overcome or not) and the concept of justice used or presupposed (for instance, whether the conception of justice emphasizes efficiency or fairness or both). The proposal put forward is that the task of medical ethics is to provide conceptual clarification and value premises relevant to justify rules of priority setting. The actual choice of such rules belongs primarily to the domain of politics.
在本文中，医疗保健中的优先次序设定被定义为个体层面的分配决策，即根据除市场之外的某些分类标准，对获得有益医疗保健的机会进行明确且直接的限制。特定优先次序设定规则的正当性既取决于概念性问题，也取决于价值前提的选择。特别重要的是所涉及的稀缺类型（供应与需求之间的失衡能否被克服）以及所使用或预设的正义概念（例如，正义概念是强调效率还是公平或两者兼顾）。本文提出的观点是，医学伦理学的任务是提供与优先次序设定规则的正当性相关的概念澄清和价值前提。此类规则的实际选择主要属于政治领域。
