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Daniels concerns himself with the requirements of justice in regard to the health of the population. He advances his opinion of setting the limits to the healthcare on the generally understood concept of resource constrain among unending needs. Following these economic problems and lack of consensuses on a rationing method, Daniels opines that it is only logical to have a fair system that fulfills this duty. To arrive at this conclusion, he integrates his works on health systems moral importance and determinants of health socially. He, thus, aims to offer a theory of health and justice (Daniels, Sabin, 2002).

            This theory anchors on Daniel's contention that in order to understand the requirements of justice on health, then the three questions have to be answered. The first question relates to the moral importance of health; the second pertains to the instances, when inequalities in health become unjust; and the last question is on how to ensure fairness in meeting the health needs, since scarcity constrains the ability to meet them all (Daniels, Sabin, 2002).  To answer them, Daniels uses Rawls theory of justice and fairness; Rawls proposes the three principles protecting equal liberties, offering fair equality of opportunity guarantee, and limiting inequalities to the smallest beneficiaries. Daniels extends Rawls’ principles and answers the three questions by stating that; first, health moral role is in offering a range of opportunity to an individual. On his second question he states that inequalities in health become unjust, when distribution of social determinants of health e.g. education, contradicts Rawls principle. In regard to the third question, Daniel concludes that legitimacy and fairness in limits setting can only be ensured by a fair process.

Walter Glannon’s: Holding People Responsible

            Glannon contends that if an individual has causal control over his behavior, then he is responsible for the resultant ill health. His perspective requires the incorporation of aspects of moral responsibility in the social health policy implementation (Glannon, 2005). Thus, Glannon requires that an individual’s entitlement to health resources be assessed both prospectively (factors determining their claim of health resources in future) and retrospectively (the way the aspects have developed the ill health). This analysis would determine their suitability as the best recipient of the scarce medical resource. However, for this principle to apply, Glannon states the four conditions to justify an individual responsibility over an illness. These are that the individual must act freely, autonomously, possess cognitive capacity of decisional consequences, and the decisions must result into the ill health (Glannon, 2005).

Milton Weinstein’s: Rationing Of Medical Resources

            Milton presents the idea of rationing as a reality that has to be dealt with. His outstanding analysis is on the cost-effectiveness of applying resources to health claims.  He argues that since it is not optional to ration medical resources, they must be rationed in the manner that offers the maximum value for the resources/money. However, it is the aspect of measuring the value of money and the gains of health, such as preserving health and prolonging life that he deals with. He opines that the Quality Adjusted Life Years (QALYs) are the most appropriate in capturing the individual preferences and life quality. Milton, thus, proposes that we should use QALYs that increase the health quality and reduce cost allocated; those that increase quality, but increase costs should be considered deeply (for instance, whether they would yield more on a different person) and those that decrease both should be abandoned (Gold, 1996).

Ezekiel Emanuel’s: Four Principles or the Just Allocation of Health Resources

            Ezekiel’s works come into closer contact with allocation of critical resources, such as organs for transplant, vaccination and medical intervention. In an attempt to solve the ethical conflict, he combines the eight principles of allocation into four principles. These are: first, equal treatment on “first come-first served” or lottery bases; secondly, allocation to the worst cases first, like the youngest or the sickest; thirdly, allocation of resources, where benefits (years or lives) are higher; and lastly, instrumental allocation that promotes the social usefulness. These principles embody the spirit of Prioritism, Utilitarianism, the social value and agree that some resources, like a heart transplant cannot be shared (Persad, Wertheimer, Emanuel, 2009).

Critical Analysis

            With regards to Daniel’s fair system it is notable that rational individuals disagree virtually on any issue on limit-setting, despite a common moral pursuit; hence, Daniel’s theory lacks authority of claiming consistency with other theories of justice, despite its claims. Additionally, the theory has the vast contribution, but its unanimous reliance on an abstract proposal of a fair system lacks practical guidance to questions of efficiency, substantive effects of limits, and compensation due to medical errors among others. It is also notable that Daniel’s idea addresses issues of when the inequalities within a society, not between the societies, are unjust. Lastly, his fairness stipulation lacks superiority in the context of dire health situation like high HIV/AIDs prevalence (Rid, n.d.).

            Unlike Norman, Glannon analyses a solution to health constraints on a micro scale of an individual; his contribution is vastly credible on both natural and logical grounds, since it cuts into policy and social approach. It eliminates aspects of free riding, irresponsibility and wastage. He bases his analysis on the understanding that individuals act with reference to the right and wrong and this should be extended to the medical issues as well. However, closer analysis reveals that there are some illnesses and social relational aspects that impair ones moral ability. Proceeding to presume such individuals as moral agents in all aspects would be erroneous.  Thus, Glannon’s perspective must evaluate an individual’s capacity to evaluate possibilities of acting freely and accommodate excusing factors. This evaluation is also difficult to determine, especially in cases of urgency, such as car accidents, since there is no time to ask a critically injured driver whether he was reckless (Fine, Kennett, 2004).

            Analysis of Milton’s rationing concept reveals that it can only work in the idea of managed healthcare and also applies to significantly large medical resources to an individual (since most of his work on QACYs are on hypertensive patients). It ignores the current challenges of affording health insurance by many or taking insurance without the actual knowledge of rationing. Thus, Milton, just like Norman and Glannon, fails to offer a rationing formula that includes all. The only solution to his approach is to offer a range of rationing scheme and then seek individual patient’s consent to the most optimal one. Thus, rationing should be by choice, since welfare maximization does not occur at the same point for all citizens and conditions of Pareto optimality apply differently in health economics (Croxson, University of Auckland, 1990).

            Analyzing Ezekiel’s principles indicate that while they broadly promise solutions for the diverse situations, problems set in while deciding on the principle to apply in a particular case. From instance, an ICU bed could be allocated on a context-sensitive argument or lottery, depending on the circumstance. Additionally, it is highly unlikely that a situation will be satisfactorily solved without application of reasoning that bends a principle. Ezekiel’s principles are likely to conflict in some instances; for example, attending the youngest, saving maximum lives and prognosis. Thus, it has its shortcomings as well, just like the other three approaches to allocation (Kerstein, Bognar, 2010).

            In conclusion, there is a need to appreciate that all the four approaches offer credible lessons. However, an allocation approach must give up an endeavor to create an umbrella approach for all. It must recognize the uniqueness of context and circumstances and blend approaches. Ultimately, there must be a decision, on which principles to apply, which would create frameworks of guiding reasoned judgment and specify a balance in principles, if they prescribe conflicting actions.

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