One of the key principles in bioethics is the principle of justice linked to law and equality. From an ethical point of view, it can be considered in three different ways and subdivided into three distinct categories, respectively: fair allocation of scarce resources (distributive justice); respect for people’s rights (rights-based justice) and compliance with morally acceptable laws (legal justice). Although the right to equal treatment, respectively, equal access to treatment has been formally enshrined in many constitutions, actually, many factors, such as age, place of residence, social status, ethnicity, culture, sexual preference, disability, legal capacity, health budgets, treatment price, insurance coverage, etc. may limit access to treatment. Justice in these cases, without neglecting or underestimating the right of equal access for all, requires that the individual’s needs be balanced with the needs of the general public.
The EU enlargement has brought new opportunities and potential problems in healthcare, while at the same time efforts are underway to harmonize healthcare provisions, including the promotion of cooperation and reaching consensus on a variety of health issues. In 1992, the Maastricht Treaty on the European Union recognized public health as an object of the EU policy. In Europe, bioethics is largely based on the principle of solidarity, freedom of choice, tolerance, equal opportunities, social justice and human dignity. In the European Community, justice and law are seen through the prism of not only the patient alone but also of his/her family members and society as a whole.
Application of passive immunotherapy with intravenous immunoglobulins having still unproven benefits could induce broader effects on society by involving considerable health and social resources. If, in the long run, the experimental treatment turns out to be an efficient and successful strategy for AD patients and, consequently, be approved of the respective regulatory authorities for routine clinical use, individuals suffering from other diseases that are also treated by the same blood product may be deprived of their therapy. Therefore, IVIG priority orientation towards AD patients would lead to a significant reduction in the therapeutic options for the persons suffering from autoimmune diseases, for instance, while the extremely high cost of the blood product may violate the principles of equality, justice and solidarity, resulting in huge over-expenditures. On the other hand, one must take into account the fact that in case of failure to use the new technology, provided that the method has proven to be working and useful, there is a risk of infringing upon the rights of the people with Alzheimer’s disease to reliable and effective treatment providing improved quality of life.
Therefore, in view of the above and in order to ensure fair and reasonable healthcare spending, it is necessary that decisions are made on a case-by-case basis, particularly in situations characterized by limited resources, unequal opportunities and/or other moral discrepancies.