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Jennifer Prah Ruger, PhD

Jennifer Prah Ruger is with the School of Medicine, Graduate School of Arts and Sciences, and Law School, Yale University, New Haven, CT.

Correspondence: Requests for reprints should be sent to Jennifer Prah Ruger, PhD, Yale University School of Medicine, 60 College St, PO Box 208034, New Haven CT 06520-8034 (e-mail: jennifer.ruger{at}yale.edu).

I trace the evolution of ethical approaches to health policy in the United States and examine a number of critical unresolved issues pertaining to the current set of frameworks. Several themes emerge.

First, fair procedures claim more attention than substantive and procedural principles. Second, in the case of public deliberation, more focus has been placed on factors such as procedural mechanisms than on understanding how individuals and groups value different aspects of health and agree on health-related decisions.

Third, the nation needs workable frameworks to guide collective choices about valuable social ends and their trade-offs; purely procedural strategies are limited in illuminating overarching health policy and ethics questions. There is a need to integrate consequential and procedural approaches to health ethics and policy.