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From The CriticsReviewer: Daniel Bustillos, JD, PhD (Saint Louis University)
Description: In this second edition, the authors improve upon their earlier book by addressing some of the criticisms of their "accountability for reasonableness" approach to healthcare resource allocation.
Purpose: Since we lack a common view of what principles should govern resource allocation in healthcare, the authors argue that we must then rely on procedural fairness to ensure just policy decision making. The authors propose a procedural model they call "accountability for reasonableness" that identifies four conditions for prioritizing in healthcare. These four criteria are then exemplified in various real-world applications.
Audience: This book is of special interest to health policy makers and health administration professionals. Healthcare ethicists, economists, and philosophers will also find this book helpful in understanding a Rawlsian approach to resource allocation quandaries. Daniels is a well-respected philosopher in the field of equity and justice in healthcare, while Sabin has been a physician and healthcare administrator for many years.
Features: The authors begin with the premise that pluralistic democratic societies cannot agree on principles for fair resource allocation. Therefore, the authors provide a fair procedure that can be accepted by all. The procedure is built upon four conditions for seeking fairness in resource allocation: 1) relevance — decisions and rationales must be based on rational deliberation that is inclusive in scope; 2) publicity — the decision making must be accessible to the public and participation of diverse publics should be actively pursued; 3) revisability — solutions generated should be tentative and provisional and there should be processes by which decisions can be revised in the light of new knowledge and mores; 4) enforcement — the preceding conditions should be assured through authoritative sanction and enforcement.
Assessment: In this new edition, the authors answer some of the critics of the first edition of their book. The authors give examples of how their rationale has been successfully used in places such as Canada, New Zealand, and the U.K. They also include a new chapter on how their approach might reduce health inequalities. As such, the book is a valuable addition to the discourse on health policy making, though it still does not adequately address the problem of whether a rationalist and proceduralist framework such as theirs can successfully ensure that everyone is heard in pluralist societies where rationalism is not the only currency of thought.