[Biomedical model of disease and criteria of distributive justice in disability pension cases].
As an expert in disability pension cases, the physician lays down important premises for the distribution of financial resources in society. The aim of this article is to present the material criteria of distributive justice of the Norwegian National Insurance Act and to carry out a constructive critique of how physicians are supposed to objectively evaluate their patients in light of these criteria. The form "Medical assessment of work disability" of the National Insurance Administration and central legal texts have been examined by using the method of text analysis. The material criteria of the Norwegian National Insurance Act, the criterion of need, of equality and of effort, are all implicitly contained in the form "Medical assessment of work disability". According to the form, the situation of the claimant should, in the light of these criteria, be evaluated by means of the biomedical model of disease. The central criterion of objectivity when applied in light of this model proves to be the ontological concept of objectivity, i.e. what exists as "objective findings". Our analysis indicates that a description and an evaluation of the claimant's situation in relation to the criteria of need, equality and vocational rehabilitation, when combined with the ontological concept of objectivity, tends to become arbitrary, insufficient and inaccurate. It is considered as problematic and unjust that little attention is given to the criterion of equality, defined as equal right for all citizens to the same actual possibilities of participation in the society, working life included, by an evaluation of disability based exclusively on the classical biomedical model of disease. The medical model of national insurance and of medicine should become more coordinated. Moreover, more weight should be given to impartial, varied and accurate evaluation according to an epistemological concept of objectivity. In this way the disability claimant's individual needs can be better clarified.
Solli
Hans Magnus
HM
Institutt for allmenn- og samfunnsmedisin, Universitetet i Oslo, Postboks 1130 Blindern, 0318 Oslo. h.m.solli@medisin.uio.no
da Silva
António Barbosa
AB
Lie
Reidar K
RK
Bruusgaard
Dag
D
D004185:Disability Evaluation; D006801:Humans; D007348:Insurance, Health / Q000331:legislation & jurisprudence; D008962:Models, Theoretical; D009664:Norway; D010415:Pensions; D010819:Physician's Role; D012935:Social Justice; D012943:Social Security / Q000331:legislation & jurisprudence; D014938:Work Capacity Evaluation