Autonomy and justice may be coming together again. Several legal cases suggest that we need the wisdom of more than one ethical principle to have an ethical managed care future. For example, in Fuja v. The transplant was denied, as the patient's insurance contract specifically prohibited experimental procedures. The Seventh Circuit Court supported Benefit Trust, seeing the issue as one of contract interpretation.
Contractual fairness is just one type of fairness.
Judging clinical cases by the wording of a contract can integrate fairness and autonomy, but it's neither the only way to do so nor a generous one. Sadly, employers who offer employees health care of any kind are as concerned with making their budgets as with helping their employees care for themselves and their families. A different approach to integrating fairness with autonomy is to try to be as scientific as possible about medicine. The procedure was denied by the Kaiser Foundation Health Plan liver transplant advisory board because, the board reportedly said, the highly infectious disease would cause the transplant to fail and was therefore contraindicated. Mr. Barnett paid privately for the procedure and then sued.