The Ethics of Health Care Rationing: An Introduction

2016

J Med Ethics

Recent research indicates that there is a gap in life expectancy between the rich and the poor. This raises the question: should we on egalitarian grounds use income-based equity weights when we assess benefits of alternative benevolent interventions, so that health benefits to the poor count for more? This article provides three egalitarian arguments for using income-based equity weights under certain circumstances. If income inequality correlates with inequality in health, we have reason to use income-based equity weights on the ground that health inequality is bad. If income inequality correlates with inequality in opportunity for health, we have reason to use such weights on the ground that inequality in opportunity for health is bad. If income inequality correlates with inequality in well-being, income-based equity weights should be used to mitigate inequality in well-being. Three different ways in which to construe income-based equity weights are introduced and discussed. They can be based on relative income inequality, on income rankings and on capped absolute income. The article does not defend any of these types of weighting schemes, but argues that in order to settle which of these types of weighting scheme to choose, more empirical research is needed.

Section: Arguments For Income-based Equity Weightsmentioning

confidence: 99%

“…Second, it is often suggested that equality of opportunity for health matters 3 19. Income is, plausibly, often correlated with opportunity for health.…”

Section: Arguments For Income-based Equity Weightsmentioning

confidence: 99%

Income-based equity weights in healthcare planning and policy

2016

J Med Ethics

“…The most common substantive principles are health maximization principles (for a good overview, see Hausman, ). For example, some suggest that health‐related resources should be allocated to minimize DALYs lost (e.g., Bognar & Hirose, ; Murray et al, ). Although substantive reasoning is important, there are three difficulties with substantive approaches that suggest health maximization from an ethical perspective.…”

Section: Principles For and Approaches To Resource Allocationmentioning

confidence: 99%

Distributing global health resources: Contemporary issues in political philosophy

Hassoun

2019

Philosophy Compass

How should states and international organizations allocate global health resources? This paper examines proposals for distributing these resources in the literature. First, we look at the literature on the metrics for measuring what matters and consider how they might be modified to avoid some common objections—e.g., that these measures discriminate against the disabled or fail to give due weight to helping the young (or old) or those in present (or future) generations. Second, we canvas existing approaches to evaluating allocations of health‐related resources utilizing such measures and advance a new way of doing so. We suggest that it is important to provide substantive arguments for directly evaluating alternative allocations, but there is also room for deliberation about fair procedures for selecting allocation criteria and securing just outcomes.

“…In the literature, as well as in the practice of healthcare rationing, two distinct approaches to the problem stand out. On one hand, it has been suggested that we need substantial, decision-guiding principles the application of which helps us to identify good rationing decisions 1. In practice, this takes the shape of, for example, a cost–benefit analysis that measures the amount of health benefits a certain intervention generates per resource unit, a principle of need that states that resources should be allocated according to health needs or of a combination of the two.…”

mentioning

confidence: 99%

The limited impact of indeterminacy for healthcare rationing: how indeterminacy problems show the need for a hybrid theory, but nothing more

2015

J Med Ethics

A notorious debate in the ethics of healthcare rationing concerns whether to address rationing decisions with substantial principles or with a procedural approach. One major argument in favour of procedural approaches is that substantial principles are indeterminate so that we can reasonably disagree about how to apply them. To deal with indeterminacy, we need a just decision process. In this paper I argue that it is a mistake to abandon substantial principles just because they are indeterminate. It is true that reasonable substantial principles designed to deal with healthcare rationing can be expected to be indeterminate. Yet, the indeterminacy is only partial. In some situations we can fully determine what to do in light of the principles, in some situations we cannot. The conclusion to draw from this fact is not that we need to develop procedural approaches to healthcare rationing, but rather that we need a more complex theory in which both substantial principles and procedural approaches are needed.