Conclusion

As an ethics issue, access to care will continue to be challenging, not so much on its merits as in the inability of the United States to act on the challenge. Norman Daniels has written, "If the glaring inequalities in access in the United States are justifiable, it must be because acceptable general moral principles provide justification for them" (p. 4). No such principles provide that justification, at least when it comes to denial of all but the most critically needed care, which is often halfheartedly provided. Thus there is no moral or ethical justification for the continued denial of access to care, whether intended or not. In the absence of any ethical defense of this ongoing denial, the explanation must be found in a lack of political and social will—and in the failure to find a workable communitarian ideal in a highly individualistic society.

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