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Social decisions associated with rationing are not yet acceptable
EDITOR,--The BMJ is a scientific journal, testing practice against theory and theory against practice and thus changing both in a verifiable progress towards the solution of human problems. These problems include two questions: how much should we spend on health care and what should we spend it on?The usual scientific approach to any question is first to observe and measure reality, in dimensions that seem most likely from past experience to provide a basis for disprovable hypotheses. Endorsed enthusiastically by Richard Smith,1 Professor Ronald Dworkin offers his "prudent insurance principle" as an innovative theory to clarify these two questions, based, he says, on five assumptions. These assumptions are not derived from any study of the real world and contradict all human experience.
He asks us to imagine a world in which wealth is justly distributed (the richest fifth of the population now gets 150 times the income of the
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- Being creative about rationing
- Richard Smith
BMJ 1996 312: 391-392.[Extract] [Full Text]
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