Precision Medicine and Distributive Justice

Metastatic cancer and costly precision medicines generate extremely complex problems of health care justice that previous theories of justice cannot address adequately. Fleck argues that what we need is a political conception of health care justice, following Rawls, and a fair and inclusive process of rational democratic deliberation governed by public reason.
While ideally just outcomes are a moral and political impossibility, "wicked" ethical problems can metastasize if rationing decisions are made in ways effectively hidden from those affected by those decisions. As Fleck demonstrates, a fair and inclusive process of democratic deliberation makes these "wicked" problems visible to public reason.