In the late 1970s and early 1980s it became clear that systematic rationing and setting of priorities had become a necessity. Second priority is for interventions which are necessary in the sense that failure will have disastrous or very grave consequences for the patient, or groups of patients, or society as a whole. To our surprise, the proposal was very well received and soon gained wide acceptance. Parliament included its main principles in a national health plan which was passed in 1988. But agreement on principles is only the beginning.
Problems remain in translating the principles into practice.
I shall mention four special issues which have generated heated discussion both among the experts and in the general public. Level I is, in fact, little more than a summary of widely accepted traditional principles where medicine and ethics meet and merge, so to speak. But the rationing of scarce resources within the limits of priority level I may generate controversy. A line has to be drawn between patients who get and those who do not get the treatment. No matter where we draw the line, some will fall below it.