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The challenge of contemporary health care distribution is to structure a framework for normative decision making whereby the goal of distributive justice is achieved equitably for as many citizens as possible. Establishing fair procedures for the distribution of health care resources is a crucial goal for contemporary society to set and, hopefully, to achieve. It is only by and through deliberate debate within a democracy that assumptions, for example, about aging, the value of life for the aged and intergenerational responsibilities of assisting them in their care can be set, tested or - as the case may be - rejected. No matter within what policy forum this debate occurs - local, state, or national - a fundamental balancing test will, of necessity, be employed; one that weighs, in an equitable and reasonable manner, individual needs with larger societal standards of economic efficiency. By seeking to integrate moral and ethical reasoning with quantitative or economic formulations of needs and resources, the opportunities for a stronger and more contemporary standard of distributive justice will be both enhanced and stabilized. The ultimate moral issue seen in this debate is not - rather surprisingly - whether too much or too little treatment is offered; but rather how to seek an optimum level of reasonable or appropriate treatment based on the medical condition of each patient. Failing to meet resolutely the inherent difficulty of allocative decisions here foredooms the total decisionmaking process to a continued state of lethargy where inaction becomes the tragic hallmark of the distribution of health care for the elderly.



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