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Evenwithinhealthcaresystemsinwhich access to health care is guaranteed—howevertheyarefunded—thiswillmeanthatsomewhoareillwillnotnecessarilyreceivetreatmentwhentheyneedit,ifatall.Themoralqualityofhealthcaredeliveredinsuchcircum-stancesofscarcitywilldependonthefairnessand justice with which such decisions aremade.Equally,withindemocraciescitizensshouldbeabletoparticipateindecisionmakingaboutissueswhichaVecttheirvitalinterests.Accesstoappropriatehealthcareisclearlyoneofthemostimportantofsuchinterests.Onthefaceofit,therefore,thewayinwhichscarcehealthcareresourcesaredistributedbetweenthosewhoneedthemisanobviouscandidateforademocraticmandate.Inattemptingtocometogripswiththemoralproblemsposedbythenecessityforhealthcarerationing,governmentsin other countries have endorsed the im-portance of public participation in settingprioritiesinhealthcarespending,ashaveothercommentators.
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Lesley Doyal (1998) studied this question.
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