Health Care Analysis

, Volume 14, Issue 3, pp 135–144 | Cite as

Fair Rationing is Essentially Local: An Argument for Postcode Prescribing

  • Richard E. AshcroftEmail author
Original Paper


In this paper I argue that resource allocation in publicly funded medical systems cannot be done using a purely substantive theory of justice, but must also involve procedural justice. I argue further that procedural justice requires institutions and that these must be “local” in a specific sense which I define. The argument rests on the informational constraints on any non-market method for allocating scarce resources among competing claims of need. However, I resist the identification of this normative account of local justice with the actual approach to local decision-making taken within the UK National Health Service. I illustrate my argument with reference to the case of provision of In Vitro Fertilisation within the UK NHS.


Justice Rationing Public health services 


  1. 1.
    Anderson E (1993) Value in ethics and economics cambridge. Harvard University Press, MassGoogle Scholar
  2. 2.
    Ashcroft RE (2002) What is clinical effectiveness? Stud Hist Philos Biol Biomed Sci 33:219–233CrossRefGoogle Scholar
  3. 3.
    Ashcroft RE (2003) IVF for all? Br Med J 327:1226CrossRefGoogle Scholar
  4. 4.
    Broome J (1991) Weighing goods. Blackwell, OxfordGoogle Scholar
  5. 5.
    Broome J (1999) Ethics out of economics. Cambridge University Press, CambridgeGoogle Scholar
  6. 6.
    Broome J (2004) Weighing lives. Oxford University Press, OxfordGoogle Scholar
  7. 7.
    Chang R (ed) (1997) Incommensurability, incomparability and practical reason. Harvard University Press, Cambridge, MassGoogle Scholar
  8. 8.
    Cohen GA (2000) If you’re an egalitarian, how come you’re so rich? Harvard University Press, Cambridge, MassGoogle Scholar
  9. 9.
    Cooper R (2002) Disease. Stud Hist Philos Biol Biomed Sci 33:263–282CrossRefGoogle Scholar
  10. 10.
    Daniels N, Sabin J (2002) Setting limits fairly: Can we learn to share medical resources? Oxford University Press, New YorkGoogle Scholar
  11. 11.
    Dasgupta P (1982) Utilitarianism, information and rights. In: Sen A, Williams B (eds) Utilitarianism and beyond. Cambridge University Press, Cambridge, pp. 199–218Google Scholar
  12. 12.
    Doyal L, Gough I (1991) A theory of human need. MacMillan, BasingstokeGoogle Scholar
  13. 13.
    Dworkin R (2000) Sovereign virtue: The theory and practice of equality. Harvard University Press, Cambridge, MassGoogle Scholar
  14. 14.
    Emanuel E (1991) The ends of human life: Medical ethics in a liberal polity. Harvard University Press, Cambridge, MassGoogle Scholar
  15. 15.
    Frankel S, Ebrahim S, Davey Smith G (2000) The limits to demand for health care. Br Med J 321:40–44CrossRefGoogle Scholar
  16. 16.
    Guyatt G, Cook D, Haynes B (2004) Evidence based medicine has come a long way. Br Med J 329:990–991CrossRefGoogle Scholar
  17. 17.
    Ham C, Robert G (2003) Reasonable rationing? International experience of priority setting in health care. Open University Press, Milton KeynesGoogle Scholar
  18. 18.
    Kolm S-C (1996) Modern theories of justice. MIT Press, Cambridge, MassGoogle Scholar
  19. 19.
    Loughlin M (1998) Impossible problems? The limits to the very idea of reasoning about management of health services. In: Dracopoulou S (ed) Ethics and values in health care management. Routledge, London, pp. 68–102Google Scholar
  20. 20.
    Loughlin M (2002) Ethics, management and mythology: Rational decision making for health service professionals. Radcliffe Medical Press, OxfordGoogle Scholar
  21. 21.
    McMillan J (2003) NICE, the draft fertility guideline, and dodging the big question. J Med Ethics 29:313–314PubMedCrossRefGoogle Scholar
  22. 22.
    New B (ed) (1997) Rationing: Talk and action in health care. BMJ Books, LondonGoogle Scholar
  23. 23.
    Nussbaum MC, Sen A (1993) (eds) The Quality of LifeGoogle Scholar
  24. 24.
    Van Parijs P (2005) Just health care in a pluri-national country. In: Anand S, Peter F, Sen A (eds) Public health, ethics and equity. Oxford University Press, Oxford, pp. 163–180Google Scholar
  25. 25.
    Pettit P (1997) Republicanism: A theory of freedom and government. Oxford University Press, OxfordGoogle Scholar
  26. 26.
    Pogge TW (ed) (2003) Global justice. Blackwell, OxfordGoogle Scholar
  27. 27.
    Rawls J (1972) A theory of justice. Oxford University Press, OxfordGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  1. 1.Biomedical Ethics, Queen MaryUniversity of London, Institute of Health Sciences EducationLondonUnited Kingdom

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