Appendix to Ethical Guidelines for the Delivery of Health Services by ...

categorization and is neither frivolous nor discriminatory.
A. The Concept of Just Rationing
Justice in rationing implies that persons who fit certain criteria
be treated equally in respect to the relevant class of services. There
is wide agreement that in rationing services the criteria applied should
be medical. Determinations of who is to receive priority should be based
on need and expected benefits and not on sociocultural or political
criteria. Justice in allocation further implies that available services
will be distributed so as not to impose an unfair burden on individuals
because of their social status, religious or racial background, or
personal characteristics unrelated to medical judgments.
Efforts made by some Congressmen, administrative officials, and
state health care personnel to exclude payment for abortion under
government-sponsored programs, for example, are attempts to substitute
political and religious considerations for medical judgments. Although
exclusion of certain benefits under federal or state programs would be
ethically permissible because of resource limitations or because the
procedures involved are known to be worthless or harmful, there is no
ethical justification for singling out recipients of government programs
as ineligible for services known to have positive health benefits that
are available to others in the population and that have a high benefit
ratio relative to costs. The arbitrary exclusion of abortion under
Title 19, or under any other federal or state program, introduces
political and religious rationing as a substitute for medical rationing.
Moreover, it establishes two standards of access to a positive health
benefit, 5 one for government recipients and another for persons in the
nongovernmental sector.
Such administrative action is a serious
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