Battisti Davide, Mannelli Chiara
Department of Law, University of Bergamo, Via Gianbattista Moroni, 255, 24127, Bergamo, BG, Italy.
Istituto Superiore di Sanità, Bioethics Unit, Via Giano Della Bella, 34, 00162, Rome, Italy.
Med Health Care Philos. 2025 Jun;28(2):327-337. doi: 10.1007/s11019-025-10263-w. Epub 2025 Mar 15.
The structural scarcity of healthcare resources has deeply challenged their fair distribution, prompting the need for allocation criteria. Long under the spotlight of the bioethical debate with an extraordinary peak during the recent COVID-19 pandemic, micro-allocation of healthcare has been extensively discussed in the literature with regard to issues of substantive and formal justice. This paper addresses a relatively underdiscussed question within the field of formal justice: who should define micro-allocation criteria in healthcare? To explore this issue, we first establish formal requirements that must be met for allocation criteria to be considered fair and legitimate. Then, we introduce three possible answers to the research question: the attending physician, the team of physicians, and the team of experts. We discuss and then reject all of them, arguing that the task of defining allocation criteria should be assigned to a political representative, supported by a cross-disciplinary team of experts. This proposal is based on the need to take democracy seriously as a tool for making substantive allocative decisions in light of the inevitable disagreement on such matters within a community. To support this claim, we present two key arguments-the democracy argument and the consistency argument. We also pre-emptively respond to two significant critiques: the too-specificity of the decision critique and the catastrophic outcomes critique. In conclusion, we argue that our proposal offers the fairest and most legitimate decision-making process for healthcare micro-allocation.
医疗资源的结构性稀缺对其公平分配提出了严峻挑战，这促使人们需要制定分配标准。长期以来，医疗资源的微观分配一直处于生命伦理辩论的聚光灯下，在最近的新冠疫情期间更是达到了顶峰，关于实质正义和形式正义问题，该领域的文献已经进行了广泛讨论。本文探讨了形式正义领域中一个相对较少被讨论的问题：谁应该在医疗保健中定义微观分配标准？为了探讨这个问题，我们首先确立了分配标准要被视为公平和合法必须满足的形式要求。然后，我们提出了对该研究问题的三种可能答案：主治医生、医生团队和专家团队。我们对所有这些答案进行了讨论，然后予以否定，认为定义分配标准的任务应该交给政治代表，并由跨学科专家团队提供支持。这一建议基于这样一种必要性，即鉴于社区内部在这些问题上不可避免地存在分歧，要将民主作为做出实质性分配决策的工具予以认真对待。为支持这一主张，我们提出了两个关键论点——民主论点和一致性论点。我们还预先回应了两种重要的批评意见：决策过于具体的批评和灾难性后果的批评。总之，我们认为我们的建议为医疗微观分配提供了最公平、最合法的决策过程。
