Principles of Need and the Aggregation Thesis

Gustavsson, Erik; Juth, Niklas

doi:10.1007/s10728-017-0346-6

Cited by 10 publications

(8 citation statements)

References 37 publications

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“…First, unlimited aggregation leads to unintuitive consequences. An unlimited aggregation view entails prioritizing minor benefits for large numbers of well-off individuals over large benefits for small numbers of worse off individuals, which can seem morally counterintuitive (Gustavsson and Juth 2019). A second reason is that the worse off are morally more important in some way.…”

Section: What Is Illness Severity and Why Should We Care?mentioning

confidence: 99%

Age and Illness Severity: A Case of Irrelevant Utilities?

Jølstad

Juth

2022

Utilitas

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Illness severity is a priority setting criterion in several countries. Age seems to matter when considering severity, but perhaps not small age differences. In the following article we consider Small Differences (SD): small differences in age are not relevant when considering differential illness severity. We show that SD cannot be accommodated within utilitarian, prioritarian or egalitarian theories. Attempting to accommodate SD by postulating a threshold model becomes exceedingly complex and self-defeating. The only way to accommodate SD seems to be to accept some form of relevance view, where some age differences are irrelevant. This view can accommodate SD, but at the expense of consistent priority orderings. Severity thus becomes unsuitable for systematic decision-making. We argue that SD should be dismissed and that we should accept a continuous relationship between severity of illness and age.

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Section: What Is Illness Severity and Why Should We Care?mentioning

confidence: 99%

Age and Illness Severity: A Case of Irrelevant Utilities?

Jølstad

Juth

2022

Utilitas

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“…A more plausible principle of need should therefore arguably allow for some restricted form of aggregation. To characterize a method of aggregation compatible with ideas about need-based priority setting is an important task with regard to the plausibility of principles of need [60].…”

Section: Priority Setting At the Policy Levelmentioning

confidence: 99%

Needs and cost-effectiveness in health care priority setting

Gustavsson

Tinghög

2020

Health Technol.

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How to balance the maximization of health and concerns for the worse off remains a challenge for health care decision makers when setting priorities. In regulatory guidelines these concerns are typically specified in terms of priority setting according to needs and priority setting according to cost-effectiveness. Still, it is often unclear when and why needs and cost-effectiveness diverge or overlap as guiding priority setting principles in practice. We conduct a comparative analysis of need and costeffectiveness in the context of health care priority setting. Based on theories of distributive justice we specify three normative interpretations of need and explicate how these relate to the normative basis for cost-effectiveness analysis. Using priority-setting dilemmas we then move on to explicate when and why need and cost-effectiveness diverge as priority-setting principles. We find that: (i) although principles of need and cost-effectiveness may recommend the same allocation of resources the underlying reason for an allocation is different; (ii) while they both may give weight to patients who are worse off they do so in different ways and to different degree; and (iii) whereas cost-effectiveness clearly implies the aggregation of benefits across individuals principles of needs give no guidance with regard to if, and if so, how needs should be aggregated. Priority setting according to needs or cost-effectiveness does not necessarily recommend different allocations of resources. Thus, the normative conflict between them, often highlighted in practice, seems exaggerated. For health policy this is important knowledge because unclear conceptions may obstruct an informed public discussion. Moreover, if decision-makers are to properly account for both principles they need to recognize the inconsistencies as well as similarities between the two.

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“…Assess the system's ability to reach out to all segments of the population/ population groups Make explicit the permissible ('good enough') standard of care being targeted and ensure it has been set in a fair and transparent manner Engage all stakeholders throughout the whole process Develop apps in a transparent manner Encourage 'bottom up', locally-relevant development that aligns with local health priorities Balance use of existing resources with the need to drive innovation that such groups have stronger entitlements to receive support rather than weaker [30].…”

Section: Similar Requirements Albeit a New Contextmentioning

confidence: 99%

Targeting ethical considerations tied to image-based mobile health diagnostic support specific to clinicians in low-resource settings: the Brocher proposition

Laflamme

Chipps

Fangerau

et al. 2019

Global Health Action

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Background: mHealth applications assist workflow, help move towards equitable access to care, and facilitate care delivery. They have great potential to impact care in low-resource countries, but have significant ethical concerns pertaining to patient autonomy, safety, and justice.Objective: To achieve consensus among stakeholders on how to address concerns pertaining to autonomy, safety, and justice among mHealth developers and users in low-resource settings, in particular for the application of image-based consultation for diagnostic support.Methods: A consensus approach was taken during a three-day workshop using a purposive sample of global mHealth stakeholders (n = 27) professionally and geographically spread. Throughout a series of introductory talks, group brainstorming, plenary reviews, and synthesis by the moderators, lists of actions were generated that address the concerns engendered by mHealth applications on autonomy, justice and safety, taking into account the development, implementation, and scale-up phases of an mHealth application lifecycle.Results: Several types of actions were recommended; key ones among them included building in risk mitigation measures from the development stage, establishing inclusive consultation processes, using open sources platform whenever possible, training all clinical users, and bearing in mind that the gold standard of care is face-to-face consultation with the patient. Recommendations of patient, community and health system participation and of governance were identified as cutting across the mHealth lifecycle.Conclusion: Priorities agreed-upon at the meeting echo those put forward concerning other domains and locations of application of mHealth. Those more forcefully articulated are the need to adopt and maintain participatory processes as well as promoting self-governance. They are expected to cut across the mHealth lifecycle and are prerequisites to the safeguard of autonomy, safety and justice.

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Principles of Need and the Aggregation Thesis

Cited by 10 publications

References 37 publications

Age and Illness Severity: A Case of Irrelevant Utilities?

Age and Illness Severity: A Case of Irrelevant Utilities?

Needs and cost-effectiveness in health care priority setting

Targeting ethical considerations tied to image-based mobile health diagnostic support specific to clinicians in low-resource settings: the Brocher proposition

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