SACHS J merely “toll the bell of lack of resources”.2 In all the open and democratic societies based upon dignity, freedom and equality with which I am familiar,3 the rationing of access to life-prolonging resources is regarded as integral to, rather than incompatible with, a human rights approach to health care. [53] Indeed, while each claimant seeking access to public medical resources is entitled to individualised consideration, the lack of principled criteria for regulating such access could be more open to challenge than the existence and application of such criteria. As a UNESCO publication put it: “Even in the industrialized nations where public tax-supported research has made a private biomedical technology industry possible, the literal provision of equal access to hightechnology care, utilized most often by the elderly, would inevitably raise the level of spending to a point which would preclude investment in preventive care for the young, and maintenance care for working adults. That is why most national health systems do not offer, or severely ration (under a variety of disguises), expensive technological care such as renal dialysis or organ transplants.”4 2 Quoted in R v Cambridge Health Authority, ex parte B [1995] 2 All ER 129 (CA) at 137c–d. In that case the judge in the Court a quo quashed the decision of a local health authority refusing to provide expensive treatment for a seriously ill child saying that “. . . the responsible authority . . . must do more than toll the bell of tight resources”. The appeal Court overturned his decision. 3 Section 39(1)(a) of the Constitution requires us, when interpreting the bill of rights, to “promote the values that underlie an open and democratic society based on human dignity, equality and freedom”. 4 Brody Biomedical Technology and Human Rights (UNESCO, Paris 1993) at 233. South Africa is a middle income country where “despite their high profile, modern lifesaving medical treatments are only available on a limited scale”, Benatar “History of Medical Ethics: Africa” Encyclopaedia of Bioethics Vol 3 Revised ed (Macmillan, New York 1995) 1465 at 1467. 29