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A, the seven-year-old son of an unemployed, uninsured single parent, was diagnosed with leukemia. A's physician recommended that he receive a bone marrow transplant, which could be performed at a medical center in a neighboring state. Applying through Medicaid, his mother was assured that funds for the operation would be available, and the necessary arrangements with the hospital were initiated. However, the state legislature shortly thereafter decided to cut Medicaid funding for heart, liver, pancreas, and bone marrow transplants. The funds were allocated, instead, to care for low-income children and pregnant women in need of medical care who would otherwise go without any medical services.

A's mother was informed that the state would not fund his operation and the hospital terminated consideration of his case until $100,000 was deposited “up front.” Friends and relatives rallied to A's support with a public fund-raising campaign that drew much media attention, but A died before sufficient funds could be raised.

Was the legislature's decision morally justifiable? How should policy makers set priorities for the allocation of health care resources?