1. The opinions expressed are those of the author and do not necessarily reflect the position or policy of the National Institutes of Health, Public Health Service, or Department of Health and Human Services.
2. Since the problem under consideration is, at least in part, practical, Daniels and Sabin rightly worry not only about actual legitimacy and fairness, but also about perceptions of legitimacy and fairness. A legitimate and fair procedure (or outcome) that is not considered either fair or legitimate by the public will not solve the problem of distrust or eliminate its more unpleasant manifestations, such as endless litigation. A consequence of that is that we need to be concerned with both what peopledo, in fact, accept as legitimate (reasonable, fair, etc.) and with what theyshouldregard as such. Of course, the two do not always coincide; and of the two, actual legitimacy should, almost certainly, take precedence - while a legitimate procedure that is not viewed as such is ‘merely’ impractical, an illegitimate procedure that is accepted as legitimate may constitute (and be a source of) injustice that is extremely difficult to remedy.
3. N. Daniels & J. Sabin. 2002.Setting Limits Fairly - Can We Learn to Share Medical Resources?Oxford, UK: Oxford University Press: chapters 1-4. Regarding the scope and intractability of our moral disagreements about resource allocation, see especially pp. 30-39. On the subject of giving priority to questions of actual, as opposed to perceived, legitimacy, see, for instance, p. 10.
4. The Ethics Of Accountability In Managed Care Reform
5. Daniels & Sabin,op. cit.note 2, p. 45.