How does the operation of PHARMAC's 'Community Exceptional ...

parents refusing treatment for their dying child (Macklin, 2003). Should the State
intervene on behalf of the child?
The distributive justice problems of state funded health services have been
discussed in the rationing literature. These problems are as critical to the
wellbeing of patients and society as the ethical issues raised by bioethicists.
Therefore, is it possible in this context to develop some specific questions about
distributive justice which explore the particular and inform some elements of
general meaning?
Can questions be developed using philosophical principles which decision
makers could ask, which draw out elements of fairness or unfairness? In an
attempt to do this, I have translated the principles of distributive justice
espoused by Rawls and Sen, into four test-questions which could be asked
about public distributions. Aligned to the Socratic tradition, there are no right or
wrong answers. The questions give an opportunity to focus on and discuss
decisions which must be made, using Rawls’ and Sen’s distributive justice
principles.
Question 1: Would the most advantaged in society accept this distribution if
they, at an instant, found themselves to be the least advantaged in
society and requiring such distribution for themselves?
This question challenges decision makers in public health systems, who by
nature of their positions are often people from well educated managerial,
medical or health professional backgrounds, to place themselves under Rawls’
veil. This test-question asks them to ignore the fact that they may be fully
functioning achievers in society with adequate resources by nature of their
talents, positions and experience. The test-question asks them to place
themselves (and their peers) in the position of the most powerless and
vulnerable person in society. It asks them to describe the world from the view
of a person needing the distribution as if they were this person, without any
other options available to them.
Question 2: Is this distribution arranged so that it is attached to positions and
offices which are open and accountable to all?
This test-question asks decision makers (and organisations) if they are making
decisions based on fairness and equity with particular emphasis on openness
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