Revisiting the judicial role in the allocation of healthcare resources: on deference, democratic dialogue and deliberation

The objective of this paper is to engage in critical reconsideration of the nature and value of the judicial role in situations where courts adjudicate upon questions connected to the allocation of scarce healthcare resources via the processes of public law. The argument posited is that the predominantly negative perspective which is adopted towards judicial involvement in issues of this type, although to some extent explicable, fails to capture the potential for public law adjudication to function as a deliberative mechanism. This is important because the dominant strand in contemporary health policy theory identifies proceduralisation through deliberative arrangements as a response to the problems, notably those of legitimacy, which have been generated by the evolution and development of explicit strategies of priority-setting or the 'rationing' of access to healthcare resources. In order to assess the prospects of the courts fulfilling a deliberative role of this type, a comparative survey of three jurisdictions in which such issues have come before the courts - England, Canada and South Africa - will be conducted.