Can judges ration with compassion? A priority-setting rights matrix

How should courts supervise health service resource allocation? Although practice varies widely, four broad approaches can be represented on a matrix comparing, on two axes, (a) individual-community rights and (b) substantive-procedural remedies. Examples from each compartment of the matrix are discussed and, although the community-procedural approach is recommended as a general rule, a range of other responses within the matrix may also be desirable

Os direitos em saúde e a racionalização no Sistema Nacional de Saúde Inglês (NHS) : da teoria à prática

ABSTRACT - How should we understand the nature of patients’ right in public health care systems? Are health care rights different to rights under a private contract for car insurance? This article distinguishes between public and private rights and the relevance of community interests and notions of social solidarity. It discusses the distinction between political and civil rights, and social and economic rights and the inherently political and redistributive nature of the latter. Nevertheless, social and economic rights certainly give rise to “rights” enforceable by the courts. In the UK (as in many other jurisdictions), the courts have favoured a “procedural” approach to the question, in which the courts closely scrutinise decisions and demand high standards of rationality from decision-makers. However, although this is the general rule, the article also discusses a number of exceptional cases where “substantive” remedies are available which guarantee patients access to the care they need.RESUMO - Como compreender a natureza dos direitos dos doentes nos sistemas de saúde públicos? São os direitos em saúde diferentes dos direitos que são objeto de contratos privados de seguro automóvel? Este artigo distingue direitos públicos e direitos privados, bem como relevância do interesse comum e noções de solidariedade social. Este artigo discute também a distinção entre direitos civis e políticos por um lado e direitos económicos e sociais por outro, sublinhando a natureza inerentemente política e redistributiva destes últimos. Apesar desta natureza, os direitos económicos e sociais estão também na origem de “direitos” passíveis de serem feitos cumprir pelos tribunais. No Reino Unido (como em muitas outras ordens jurídicas) os tribunais têm favorecido uma solução jurídica “procedimental” para as questões aqui suscitadas, escrutinando de muito perto os decisores e exigindo-lhes elevados padrões de racionalidade nas suas decisões. Todavia, apesar de esta ser a regra geral, discutem-se também neste artigo alguns casos de exceção onde soluções jurídicas “substantivas” foram adoptadas, garantindo aos pacientes, por essa via, o acesso aos cuidados de saúde de que necessitam.info:eu-repo/semantics/publishedVersio

Health equality, social justice and the poverty of autonomy

How does the concept of autonomy assist public responses to ‘lifestyle’ diseases? Autonomy is fundamental to bioethics, but its emphasis on self-determination and individuality hardly supports public health policies to eat and drink less, and take more exercise. Autonomy rejects a ‘nanny’ state. Yet, the cost of diseases caused by obesity is increasing to individuals personally and to public health systems generally. Health care systems are under mounting and unsustainable pressure. What is the proper responsibility of individuals, governments and corporate interests working within a global trading environment? When public health care resources are unlikely to increase, we cannot afford to be so diffident to the cost of avoidable diseases