title: The limited impact of indeterminacy for healthcare rationing: how indeterminacy problems show the need for a hybrid theory, but nothing more.
abstract: A notorious debate in the ethics of healthcare rationing concerns whether to address rationing decisions with substantial principles or with a procedural approach. One major argument in favour of procedural approaches is that substantial principles are indeterminate so that we can reasonably disagree about how to apply them. To deal with indeterminacy, we need a just decision process. In this paper I argue that it is a mistake to abandon substantial principles just because they are indeterminate. It is true that reasonable substantial principles designed to deal with healthcare rationing can be expected to be indeterminate. Yet, the indeterminacy is only partial. In some situations we can fully determine what to do in light of the principles, in some situations we cannot. The conclusion to draw from this fact is not that we need to develop procedural approaches to healthcare rationing, but rather that we need a more complex theory in which both substantial principles and procedural approaches are needed.
authors.forename: Anders
authors.identifier: http://orcid.org/0000-0002-9885-8106
authors.initials: A
authors.lastname: Herlitz
mesh_terms: D003210:Concept Formation; D003657:Decision Making / Q000941:ethics; D026689:Ethical Analysis; D028663:Ethical Theory; D004992:Ethics, Medical; D014943:Global Health; D015276:Health Care Rationing / Q000941:ethics*; D006801:Humans
keywords: Allocation of Health Care Resources; Ethics; Philosophical Ethics; Political Philosophy; Resource Allocation