Health Care Under Market Conditions: An Ethical Analysis

Health care systems in many countries in the Western World face major challenges, esp. economic ones, due to both rising human life expectancy and to the enormous costs of technical innovations in medicine, e.g. in diagnostic imaging, in cell, tissue and organ transplantation, and possibly in near future of stem cell research. The central question raised by such developments is whether economic conditions are to be subordinated to the patient’s needs or the patient’s needs to economic conditions? The contribution of ethics consists in a critical examination of the justifiability of moral claims. This includes identifying normative preconditions and possible conflicts between norms. This must take place on both individual and collective levels of analysis. The following paper will thus fall into three parts: 1. an examination of the (collective) ethical foundation of providing sufficient resources for health care on the three levels involved: the macro or resource-raising level, the meso or resource-distributing level, and the micro or resource-allocating level, 2. an analysis of the (individual) ethical basis of securing medical ethos under the condition of economic efficiency, and finally 3. an inquiry into the logic of the relation between prioritization and rationing from an ethical point of view.