Fleck Leonard M
Michigan State University, East Lansing, MI 48824-1032, USA.
J Med Philos. 2011 Dec;36(6):589-611. doi: 10.1093/jmp/jhr052. Epub 2011 Dec 13.
What should be the content of a package of health care services that we would want to guarantee to all Americans? This question cannot be answered adequately apart from also addressing the issue of fair health care rationing. Consequently, as I argue in this essay, appeal to the language of "basic," "essential," "adequate," "minimally decent," or "medically necessary" for purposes of answering our question is unhelpful. All these notions are too vague to be useful. Cost matters. Effectiveness matters. The clinical circumstances of a patient matters. But what we must ultimately determine is what we mutually agree are the just claims to needed health care of each American in a relatively complex range of clinical circumstances. Answering this question will require a public moral conversation, a fair process of rational democratic deliberation aimed at defining both just claims to needed health care and just limits.
我们想要向所有美国人保证的一揽子医疗保健服务的内容应该是什么？如果不解决公平的医疗保健配给问题，这个问题就无法得到充分回答。因此，正如我在本文中所论证的，为了回答我们的问题而诉诸“基本的”“必不可少的”“足够的”“最低限度体面的”或“医学上必要的”等表述是没有帮助的。所有这些概念都过于模糊，没有实际用途。成本很重要。有效性很重要。患者的临床情况很重要。但我们最终必须确定的是，在相对复杂的一系列临床情况下，我们共同认为每个美国人对所需医疗保健的合理诉求是什么。回答这个问题将需要进行一场公共道德对话，这是一个公平的理性民主审议过程，旨在界定对所需医疗保健的合理诉求以及合理限度。
