Abstract

A common difficulty with the application of theories of justice to the allocation of medical resources is the assumption that one perspective is primary, whether that privileged perspective be that of the practitioner, on the one hand, or policy analyst on the other. By a discussion of three theories — those of Ramsey, Childress, and Joseph Fletcher — I attempt to show that these perspectives must be treated as related. As a result, values and ethics expressed in micro-allocation should be uniform with those of macro-allocation. This point has implications for such issues as substance and procedure in just decision, the role of the political process in medical allocation, and the definition of health and health services.