When conflicting claims are pressed under conditions of relative scarcity, under which all claims cannot easily be met, problems of justice typically arise. Consider, for example, the problem of distribution of spaces on kidney dialysis machines, a problem we discussed earlier in Chapter One. More patients require spaces on such machines than can be treated. There simply are not enough dialysis machines. Yet many untreated patients surely will die. How are the spaces to be allotted? What is the just distribution?
Considerations of justice might not be pressing if there were enough slots for everyone and if provision of sufficient machines would not deplete other contested resources. Then, everyone could easily be treated and no problem would exist. Or, if some patients withdrew their claims to treatment so that all who demanded treatment could be treated, issues of justice would not arise. But when conflicting claims are pressed under conditions where not all claims can be satisfied, we are often called upon to resolve the conflict justly.
In the case of the dialysis machines, should spaces be distributed by lottery? Such a procedure would at least count all applicants equally. But is equal treatment always just treatment? People often differ in merit. Perhaps places on the machine should go to the meritorious. Remember the