健康照護分配正義之理論與挑戰【本期企劃】 試閱
Healthcare Distributive Justice: Theories and Challenges
在資源有限與醫療科技快速擴張下，健康照護分配不可避免地面臨悲劇選擇之挑戰。但健康照護分配之本質並非純粹醫療專業或技術問題，而是牽涉多元價值之抉擇，而政治哲學之分配正義理論可提供健康照護分配之基本規範原則與正當化基礎。本文藉由檢視效益主義、Robert Nozick之權能理論、John Rawls之正義論、Norman Daniels之正常機會範圍理論與合理論責機制、Ronald Dworkin之審慎保險理論、與Amartya Sen之基本能力）理論，討論分配正義理論如何回應健康照護分配面臨之核心難題：包括需求界定過廣、優先順序難以明確、及在資源稀缺與多元價值衝突並存之現實條件下難以提出具體分配標準等挑戰。
Healthcare distribution unavoidably involves hard decisions and tragic choices due to resource scarcity and the rapid expansion of medical technologies. However, decisions regarding healthcare distribution are not merely a technical matter of medical expertise, organizational design, or economic efficiency. Rather, they are inherently value-laden, shaped by plural and conflicting moral, cultural, and social commitments. In this context, political philosophy — particularly theories of distributive justice — provides essential normative foundations for evaluating how healthcare resources ought to be distributed and for determining what constitutes a justified distribution principle. This article examines several influential theories of distributive justice, including utilitarianism, Robert Nozick’s entitlement theory, John Rawls’s theory of justice, Norman Daniels’s account of the normal range of opportunity and his framework of accountability for reasonableness, Ronald Dworkin’s prudent insurance model, and Amartya Sen’s basic capabilities approach. Through this survey, the article explores how these theories address persistent challenges in healthcare distribution, including the overly expansive scope of health-care needs, the difficulty of establishing operational priority-setting criteria, and the struggle to reconcile normative ideals with the realities of scarce resources and deep value pluralism.
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