Social Justice and Rationing Social Services

This paper discusses the ethical implications of different mechanisms used by social agencies to ration scarce social services. Mechanisms such as "queing," "creaming," and "triage" are discussed from the perspective of two theories of social justice; i.e., John S. Mill and John Rawls. The purpose of the paper is to encourage more explicit examination of the assumptions that underlie the distribution of social services. It is the authors' contention that the present decision making process is almost entirely based on intuition, political expedience, and tradition, and that systematic ethical analysis would give stronger justification to rationing decisions. Since social services i are a finite and valuable commodity, they can only be offered to a limited number of people, and therefore, are denied to others. This dilemma is common to all health and social service programs, from day care to CT Scanners, from kidney dialysis machines to counseling services. Granted some services are in greater supply than others, and some may be oversupplied (e.g., information and referral); however, these are the exception rather than the rule. The supply of most social services is restricted and, therefore, must be rationed in some manner. Given this necessity, there is value in formulating a rational framework which explicates alternative ethical principles 2 as a step toward determining which social services should have priority over others, and which people should have the greater claim to them. This article will present two fundamentally different theories of distributive justice and illustrate how each can be applied in assessing the ethical implications "'Social Services" as used in this paper refers to personal social services such as counseling, day care, homemakers, residential treatment as well as broader social welfare provisions such as public assistance, food stamps, and manpower services. 2 The terms "ethical" and "moral" are often used as equivalent by philosophers and pertain to concepts such as "good" and "right" (Frankena, 1963:Chapter 1).