Ethical health resources allocation: Why the distinction between ‘rationing’ and ‘rationalization’ matters

Maria do Céu Patrão Neves


Allocation of health resources has an irreducible ethical dimension, thus cannot be decided only technically, but must be ethically weighed, what paradigmatic experiences of macro (Oregon Basic Health Services Act, 1989) and micro allocation (God’s Committee, 1962) have shown. Justice is required in the enunciation of prioritization criteria, and transparency in its application. In situations of aggravated resource scarcity, it is common to take ‘allocate’ and ‘rationing’ as synonyms or claim that ‘allocate’ is always ‘rationing’. Rejecting these positions, there is a distinction between 'allocating' (resource management) from 'rationing' (allocation of limited resources to a limited number of persons) and 'rationalizing' (optimization of available resources). These distinctions are ethically pertinent, showing how only 'rationalization' respects justice, transparency and human dignity.

Palabras clave

allocation; rationing; rationalization; justice; transparency; human dignity

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Aristóteles, Ética a Nicómaco, Livro V, 1131a, 21-24.

Beauchamp, T. e Childress, J. (2009). Principles of Biomedical Ethics (6ª ed.), 272-273. New York/Oxford, Oxford University Press.

Brock, D. W. e Wikler, D. (2006), Ethical Issues in Resource Allocation, Research, and New Product Development. Em D.T. Jamison, Breman JG, Measham AR, et al. (Eds.), Disease Control Priorities in Developing Countries (2nd edition), chapter 14. Washington (DC) / The World Bank; New York/Oxford University Press.

Caplan, A. (2020). New York’s bioethics experts prepare for wave of difficult decisions. Washington Post, March 28: [Consulta: 12.06.2020].

Carrieri, D.; Peccatori, F. e Boniolo, G. (2020). COVID-19: a plea to protect the older population. Int J Equity Health 19: 72.

Daniels, N. (1985). Am I My Parents’ Keeper. Just Health Care (studies in Philosophy and Health Policy), 86-113. Cambridge, Cambridge University Press,

Daniels, N. (1988). Just Health and Am I My Parents’ Keeper. New York, Oxford University Press.

Deutscher E. (2020). Solidarity and Responsibility during the Coronavirus Crisis, Ad Hoc Recommendation, 3-4: [Consulta: 12.06.2020].

Emanuel, E. J.; Persad, G.; Upshur, R.; et al. (2020). Fair Allocation of Scarce Medical Resources in the Time of Covid-19. The New England Journal of Medicine 382: 2049-2055.

Encyclopedia Britannica: [Consulta: 12.06.2020].

Golenski, J. D. e Thompson, S.M. (1991). A History of Oregon's Basic Health Services Act: An Insider's Account. QRB Qual Rev. Bull. 17, 5, 144-149.

Jonsen, A. R. (1998). The birth of Bioethics, pp. 211-214. New York / Oxford, Oxford University Press.

Kilner, J. F. (1995). Health-care resources: I. Macroallocation. Em W. T. Reich (Ed.), Encyclopedia of Bioethics (revised edition), volume 2, 1067-1075. New York, USA: Macmillan Library.

Levine, C. (2009). The Seattle 'God Committee': A Cautionary Tale. Health Affairs, November, 30.

Ministerio Sanidad de España, (2020). Informe sobre los aspectos éticos en situaciones de pandemia: El SARS-CoV-2: [Consulta: 12.06.2020].

Morone, J. A. e Ehlke, D. (2013). Health Politics and Policy (5th edition). Australia: Cengage Learning.

Nações Unidas, Declaração Universal dos Direitos Humanos (1948, ed. 2009): [Consulta: 12.06.2020].

Patrão Neves, M. (2020). Ethical implications of ‘Rationing’ vs ‘Rationalization’. Eubios Journal of Asian and International Bioethics 30, 4, 134-135.

Robinson, R. (2009). Cost-utility analysis, BMJ 1993 Oct 2, 307, 6908, 859–862.

Solomon, M. Z.; Wynia, M. K. e Gostin, L. O. (2020). Covid-19 Crisis Triage — Optimizing Health Outcomes and Disability Rights. The New England Journal of Medicine: [Consulta: 12.06.2020].

Spicer, J. (2010). Oregon and the UK: experiments in resource allocation. J. Prim. Care (Abingdon), London, 2010 Dec 3, 2, 105-108.

Sulmasy, D. (2007). Cancer Care, Money, and the Value of Life: Whose Justice? Which Rationality? Journal of Clinical Oncology 25, 2, 217-222.

World Health Organization (2019). Global Spending on Health: A World in Transition, 68 pp.


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