Herlitz Anders
J Med Ethics. 2016 Jan;42(1):22-5. doi: 10.1136/medethics-2015-102937. Epub 2015 Nov 3.
A notorious debate in the ethics of healthcare rationing concerns whether to address rationing decisions with substantial principles or with a procedural approach. One major argument in favour of procedural approaches is that substantial principles are indeterminate so that we can reasonably disagree about how to apply them. To deal with indeterminacy, we need a just decision process. In this paper I argue that it is a mistake to abandon substantial principles just because they are indeterminate. It is true that reasonable substantial principles designed to deal with healthcare rationing can be expected to be indeterminate. Yet, the indeterminacy is only partial. In some situations we can fully determine what to do in light of the principles, in some situations we cannot. The conclusion to draw from this fact is not that we need to develop procedural approaches to healthcare rationing, but rather that we need a more complex theory in which both substantial principles and procedural approaches are needed.
医疗资源分配伦理中一场臭名昭著的辩论涉及到是用实质性原则还是程序性方法来处理资源分配决策。支持程序性方法的一个主要论点是，实质性原则是不确定的，以至于我们对于如何应用这些原则会存在合理的分歧。为了应对不确定性，我们需要一个公正的决策过程。在本文中，我认为仅仅因为实质性原则不确定就摒弃它们是错误的。旨在处理医疗资源分配的合理实质性原则确实可能是不确定的。然而，这种不确定性只是部分的。在某些情况下，我们可以根据原则完全确定该做什么，而在某些情况下则不能。从这一事实得出的结论不是我们需要开发医疗资源分配的程序性方法，而是我们需要一个更复杂的理论，在这个理论中，实质性原则和程序性方法都是必要的。
