Priority setting in health care: on the relation between reasonable choices on the micro-level and the macro-level

There has been much discussion about how to obtain legitimacy at macro-level priority setting in health care by use of fair procedures, but how should we consider priority setting by individual clinicians or health workers at the micro-level? Despite the fact that just health care totally hinges upon their decisions, surprisingly little attention seems being paid to the legitimacy of these decisions. This paper addresses the following question: what are the conditions that have to be met in order to ensure that individual claims on health care are well aligned with an overall concept of just health care? Drawing upon a distinction between individual and aggregated needs, I argue that even though we assume the legitimacy of macro-level guidelines, this legitimacy is not directly transferable to decisions at micro-level simply by adherence to the guidelines’ recommendation. Further, I argue that individual claims are subject to the formal principle of equality and the demands of vertical and horizontal equity in a way that gives context- and patient-related equity concerns precedence over equity concerns captured at the macro-level. I conclude that if we aim to achieve just health care, we need to develop a complementary framework for legitimising individual judgment of patients’ claims on health care resources. Moreover, I suggest the basic structure of such a framework.     

From Argument to Assertion

Acceptance or rejection of factual assertions is a far more important process than logical validation of arguments. Not only are assertions more persuasive than arguments; this is desirable, since we want our beliefs and actions to be reasonable and not just rational. When do we resort to argument? Real speeches heavy on arguments aim to present the speaker as calm, serious, and knowledgeable. In public life, one argues not in order to demonstrate the claim for which one is arguing, but to show that one shares the common prejudices or values that appear in the presuppositions and conclusions of one’s argument, and to demonstrate mastery of the subject matter by displaying relevant knowledge in coherently organized detail. Arguing is thus a way of presenting facts and principles so as to show one’s character as worthy of trust.     

Rationality,Reasonableness, and Critical Rationalism: Problems with the Pragma-dialectical View

A major virtue of the Pragma-Dialectical theory of argumentation is its commitment to reasonableness and rationality as central criteria of argumentative quality. However, the account of these key notions offered by the originators of this theory, Frans van Eemeren and Rob Grootendorst, seems to us problematic in several respects. In what follows we criticize that account and suggest an alternative, offered elsewhere, that seems to us to be both independently preferable and more in keeping with the epistemic approach to arguments and argumentation we favor.