As an ethical guideline, distributive justice has received relatively little attention in traditional clinical and professional ethics. In the managed care era, considerations of justice can no longer be ignored.
Justice enjoins physicians to allocate scarce medical resources in an equitable manner.
As already discussed, physicians need to use their expertise to help fulfill the socially important goal of controlling the costs of care. In allocating resources, justice or fairness requires that patients who are similar in clinically and ethically relevant ways should be treated similarly. Disturbingly, decisions by managed care plans may be inconsistent. In disputed cases, insurance plans may be more likely to authorize coverage when patients are more persistent and knowledgeable in their demands. A single insurance plan would make different coverage decisions for clinically similar patients.