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4. 
Justice is in its broadest sense about equality
and fairness.
 Allocation of medical resources must be fair and
according to need.
 _ Physicians should not make decisions regarding
individuals based upon societal needs

5.  Distributive justice
 Legal justice
 Rights based justice

6. fair distribution of limited resources among members of
society i.e. fair healthcare rationing.

7. Legal justice
application of legislation by a judge, magistrate or a supreme court of a
country or state, with the objective of protecting victims/patients and
punishing/re-habilitating the perpetrators who have broken the law.

8. Rights based justice
respect of people's rights rather than the application of law.
These social rights relate to our society’s belief that every individual
and group is entitled to fair and equal rights and participation in
social, educational, health and economic opportunities.

10.  Distributive justice
 fair distribution of limited resources among members of
society i.e. fair healthcare rationing.
 Legal justice
 application of legislation by a judge, magistrate or a
supreme court of a country or state, with the objective of
protecting victims/patients and punishing/re-habilitating
the perpetrators who have broken the law.
 Rights based justice
 respect of people's rights rather than the application of
law.
These social rights relate to our society’s belief that every
individual and group is entitled to fair and equal rights and
participation in social, educational, health and economic
opportunities.

11.  In fact, our society uses a variety of factors as a
criteria for distributive justice, including the
following:
 to each person an equal share
 to each person according to need
 to each person according to effort
 to each person according to contribution
 to each person according to merit
 to each person according to free-market
exchanges

13.  Full
measure of service and devotion by
Physician
"In the Principles of Ethics of the American
Medical Association’’

14. such as:
 Equipment,
 Beds,
 Drugs,
 Time or
 Excessive numbers of persons in need
make it difficult.
Decisions for painful tradeoffs in a fair and
compassionate manner.

15. “rationing” decision must be made.
needed thing or procedure is in short supply to those who
need it & by fair distribution.
The reasons for shortage can be many. E.g:
there are many more patients with end stage cardiac disease
or liver disease than there are cadaver organs available;
expensive equipment( lacking)
beds may be limited;
costly medicine;
few skilled personnel
Unavailable insurance coverage.
More dialysis patients than machines
Many bioethicists argued that a lottery or a "first-come, first-
served" , “serious need” criteria would have been more
equitable and ethically justifiable.

16. Triage (which means "choice" or "selection") is
a disaster or in the crowded emergency
department of an urban hospital.
Again, the common sense rule
is to serve persons whose condition requires
immediate attention and, if this attention is
not given, will progress to a more serious
state. Others, whose condition is not as
serious and who are stable, may be deferred.

17.  This rule is justified only because of the
clear necessity of general public welfare in a
crisis.
 second sort of triage is indicated in
disasters, such as earthquakes, or in military
action.
 the physician to attend first to those who
can be quickly and successfully treated in
view of a speedy return to the battlefield, or
to treat commanders before troops in order
to assure leadership

18.  to give priority to one patient over another.
 Many of these reasons for shortage are the
result of deliberate decisions to ration.
 The practical ethical question is: can a fair
and just allocation be actually implemented
in a particular social, economic and medical
climate?

19.  Several ethical theories have been elaborated to
formulate criteria for fair and just distribution
and to examine the arguments for a "right to
health care.“
At present, little agreement exists on any of these
issues. Ideally, all persons should have access to
a "decent minimum" of health care necessary to
sustain life, prevent illness, relieve distress and
disability,
so that, in the words of one bioethicist, "each
person may enjoy his or her fair share of the
normal opportunity range for individuals in his or
her society

21.  Debates over this issue have been lengthy
and serious. Many policy proposals have been
considered: some implemented and others
rejected. However, in the systems of
managed health care now so common in
American medicine, the question of fair and
just allocation of resources must be raised
and the various policies and criteria for
allocating resources must be reviewed for
their fairness and equitability.

22.  Some specific examples of public policy in devising an allocation
system concentrate on the criteria of efficiency and cost-
effectiveness. The state of Oregon is unique in having such a
system for its Medicaid patients: a long list of medical
procedures, ranked in terms of their cost/benefit
ratio, determines the reimbursement policy. Even with such a
system, ethical criteria must also be considered: what is to be
done if life-saving and life-sustaining interventions rank low on
cost-effectiveness? Is it ethical to omit the rescue of a person
from death because their rescue by, say, bone marrow
transplantation is less cost-effective than some preventive
measures? How is cost-effectiveness to be applied to persons with
shorter natural life expectancy, such as the elderly? These
questions are not easily answered but they must be consistently
raised whenever allocation systems are proposed. Some forms of
allocation are obviously unethical in any society that values
justice.
 For example, making the ability to pay the only way of obtaining
medical care or distributing medical resources to the friends or
political colleagues of those in power. Many other problems are
less obviously unethical but still need to be evaluated and
debated