[High-cost therapy. Ethical principles of allocation of scarce resources]

This article raises some ethical problems concerning high-cost therapy for malignant haematological diseases. The problem of setting priorities is discussed within the framework of utilitarianism, right-based theories and the contractarian theory of John Rawls. It is argued that utilitarianism can provide precise answers, based on the principle of allocative efficiency. However, this is not the only objective of a public health care system. The right-based approach is discussed, but sufficiently precise definitions seem hard to formulate. The contractarian approach is regarded as interesting, since it tries to address the question of trade-offs between objectives of allocative efficiency and distributive fairness.