Rapid responses are electronic comments to the editor. They enable our users
to debate issues raised in articles published on bmj.com. A rapid response
is first posted online. If you need the URL (web address) of an individual
response, simply click on the response headline and copy the URL from the
browser window. A proportion of responses will, after editing, be published
online and in the print journal as letters, which are indexed in PubMed.
Rapid responses are not indexed in PubMed and they are not journal articles.
The BMJ reserves the right to remove responses which are being
wilfully misrepresented as published articles or when it is brought to our
attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not
including references and author details. We will no longer post responses
that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
The authors confidently declare that 'everyone can agree' that
characteristics such as 'social staus, mental and physical disability, and
ability to pay are irrelevant' to decisions about allocation of healthcare
resources.
I would disagree, suggesting that justice may require such factors to
given special weight for some patients. Rawls 'difference principle'
states that 'where economic and social inequalities exist, then they must
be conditional on being of greatest benefit to the least advantaged in
society.'(1)
Patients may suffer physical and or mental disability as direct
consequence of the condition for which they seek treatment so it is
nonsense to suggest that such a factor is irrelevant in allocation of
resources, but even if the condition being considered is separate from the
cause of diasbility, priority may be justified to help alleviate the
effects of the combination. Cataract surgery being prioritised for a
patient with terminal illness would be a good example.
Similarly, patients who are socially disadvantaged and unable to fund
alternatives to subsidised healthcare would to my mind quite justifiably
be pushed to the front of the queue, on the basis that others have
alternative ways of obtaining the same care.
The bottom line is that just decisions can only be made on an
individual basis when the facts of the case are known, and attempts to
deal with population groups only must leave room for manoeuvre to
compensate for individual needs.
(1) J. Rawls, A Theory of Justice (Cambridge, Harvard University
Press, 1971)
Don't assume everyone agrees with you.
The authors confidently declare that 'everyone can agree' that
characteristics such as 'social staus, mental and physical disability, and
ability to pay are irrelevant' to decisions about allocation of healthcare
resources.
I would disagree, suggesting that justice may require such factors to
given special weight for some patients. Rawls 'difference principle'
states that 'where economic and social inequalities exist, then they must
be conditional on being of greatest benefit to the least advantaged in
society.'(1)
Patients may suffer physical and or mental disability as direct
consequence of the condition for which they seek treatment so it is
nonsense to suggest that such a factor is irrelevant in allocation of
resources, but even if the condition being considered is separate from the
cause of diasbility, priority may be justified to help alleviate the
effects of the combination. Cataract surgery being prioritised for a
patient with terminal illness would be a good example.
Similarly, patients who are socially disadvantaged and unable to fund
alternatives to subsidised healthcare would to my mind quite justifiably
be pushed to the front of the queue, on the basis that others have
alternative ways of obtaining the same care.
The bottom line is that just decisions can only be made on an
individual basis when the facts of the case are known, and attempts to
deal with population groups only must leave room for manoeuvre to
compensate for individual needs.
(1) J. Rawls, A Theory of Justice (Cambridge, Harvard University
Press, 1971)
Competing interests:
None declared
Competing interests: No competing interests