Public participation and the moral quality of healthcare rationing.

Health services throughout the world do not have enough resources to meet the healthcare needs of all of their citizens. Therefore, some form of rationing within health services is inevitable. Even within healthcare systems in which access to health care is guaranteed— however they are funded—this will mean that some who are ill will not necessarily receive treatment when they need it, if at all. The moral quality of health care delivered in such circumstances of scarcity will depend on the fairness and justice with which such decisions are made. Equally, within democracies citizens should be able to participate in decision making about issues which aVect their vital interests. Access to appropriate health care is clearly one of the most important of such interests. On the face of it, therefore, the way in which scarce health care resources are distributed between those who need them is an obvious candidate for a democratic mandate. In attempting to come to grips with the moral problems posed by the necessity for healthcare rationing, governments in other countries have endorsed the importance of public participation in setting priorities in healthcare spending, as have other commentators. In this paper, I will argue that whereas the involvement of the public is crucial for the eVective and eYcient practice of health care, it has a limited role in making decisions about healthcare rationing. Some forms of rationing will be shown to be morally wrong, irrespective of their actual or potential popularity.