In this chapter the essential issue of fairness is discussed as it is (and should be) a cardinal feature of existing and any future rationing method. The central characteristics of fairness, as it is functionally defined here, are described as are examples of failures in allocation fairness in both organ transplantation and in the Oregon Health Plan. It notes that while the consequences of not receiving an organ or a scarce drug may be death or serious injury, the allocation methods are generally accepted (even though there are desperate patients involved), because they are fundamentally judged as fair. There is a detailed description of the author’s adaptation and expansion of Norman Daniels’s and James Sabin’s “accountability for reasonableness” approach to deciding how to allocate scarce resources. The discussion is illustrated with actual case examples.
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