Recently, I have been getting in conversations with people who are politically active. The main discussion point I find myself struggling to be able to answer is the ethics of single-payer health care systems. He claimed that everyone would be able to get health care from anywhere. My response was the government can limit the services someone is allowed to have. His response was that not everyone is deserving of a service they ask for. For some background on single-payer health care systems:

The single payer [model] tends to have considerable market power to negotiate for lower prices; Canada’s system, for example, has negotiated such low prices from pharmaceutical companies that Americans have spurned their own drug stores to buy pills north of the border. National Health Insurance plans also control costs by limiting the medical services they will pay for, or by making patients wait to be treated.

A similar problem regarding cost control and refusing to pay for services can be found in traditional models of private insurance. However, the outcome is still the same; someone is denied a healthcare service.

Traditional insurance, to the extent that it insulates the patient from almost all costs, will eventually adopt access restrictions and even price controls just like government- run plans. And that development undermines our principle of patient choice.

The problem I ran into it in formulating a response exists in practical ethics. The principle of beneficence/non-maleficence would say that the patient absolutely is deserving of the procdure/treatment if it is beneficial to them and prevents them from being injured. Justice would say that whoever is most deserving of a procedure/treatment should receive it. The principle of autonomy would state that only the patient has the right to deny or accept a treatment/procdure.

With all of these disagreements amongst some of the basic prinicples of health care ethics, I found a base question that must be answered for a response can be properly formulated. Therefore, whether it be for any reason, can we be in the ethical and still deny someone a health procedure to treatment, even if that procedure or treatment is necessary?

  • Which disagreements are you referring to specifically? I'm not sure I see anything in your description that explicitly conflicts, unless there is a hidden assumption that "justice" obligates an adult to receive a treatment they don't want for themselves.
    – Uueerdo
    Commented Feb 18, 2020 at 19:58

3 Answers 3


You mention justice as the reason to give someone a treatment that needs it, but one must also consider the virtue of prudence, as it is not always possible to make these decisions in a vacuum. Given the reality of finite resources (money, time, medical professionals), only so many treatments are available at a time, so there has to be a system for deciding who will get procedures and who will not. That some are denied procedures is not, in itself, unethical, but rather a function of how this is decided.

  • And Canada's ERs are now oversaturated.
    – Joshua
    Commented Oct 2, 2022 at 21:35

... the patient absolutely is deserving of the procdure/treatment if it is beneficial to them and prevents them from being injured. Justice would say that whoever is most deserving of a procedure/treatment should receive it.

Problematic reasoning. One dramatic example for it:

The patient could be a terminally ill convicted serial child killer requiring a treatment that costs millions to taxpayers, among whom are some whose children she killed.

Would it be justice to force higher taxes on these now childless parents for treatment of this person?

I think not.

  • 1
    'Deserving of treatment' is a turn of phrase that hides the fact that somebody needs to perform the treatment and somebody needs to pay for the treatment, and that it would be highly unethical to force either of those on an unwilling individual. Commented Feb 20, 2017 at 21:10
  • One problem with the example, at least as an argument against a single payer system, is that since prisons are responsible for the health of their inmates the "convicted serial child killer" gets exactly that.
    – Uueerdo
    Commented Feb 18, 2020 at 19:55
  • Maybe we need to speed up the death penalty process? The longer an unwanted situation exists, the more likely we are to face these vexing conundrums.
    – Scott Rowe
    Commented Sep 10, 2022 at 0:51

It also depends on what is meant by need. A person might feel they 'need' a treatment but it might be deemed 'futile' by health-care practitioners, it might not produce the desired outcome, or it might produce an outcome of little value. If a procedure is deemed futile there is no moral obligation to provide it. Who pays and how they pay is not the point.to squander resources would be unethical.

  • So if someone wants a treatment and can't find anyone who will provide it, that solves the problem.
    – Scott Rowe
    Commented Sep 10, 2022 at 0:53

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