Prioritarianism in Health-Care: Resisting the Reduction to Utilitarianism (original) (raw)

Defending Deontic Constraints and Prioritarianism: Two Remarks on Tännsjö’s Setting Health-Care Priorities

Diametros

Torbjörn Tännsjö has written a clear and thought-provoking book on healthcare priority setting. He argues that different branches of ethical theory—utilitarianism, egalitarianism, and prioritarianism—are in general agreement on real-world healthcare priorities, and that it is human irrationality that stands in the way of complying with their recommendations. While I am generally sympathetic to the overall project and line of argumentation taken by the book, this paper raises two concerns with Tännsjö’s argument. First, that he is wrong to set aside deontic constraints as irrelevant or as pointing in the same direction as consequentialism. Secondly, that his argument against prioritarianism in favor of utilitarianism is insufficient and under-developed. Given these problems, I conclude that we should welcome Tännsjö’s contribution but with these qualifications in mind.

Responsibility, fairness and rationing in health care

Health Policy, 2006

Objective: People make different choices about how to live their life and these choices have a significant effect on their health, the risks they face and their need for treatment in the future. The objective of this article is, drawing on normative political theory, to sketch an argument that assigns a limited but significant role to individual responsibility in the design of the health-care system. Method: In developing our argument, we proceed in five steps. First, we review the literature on criteria for priority setting. Second, we explore the most prominent contemporary tradition in normative theory, liberal egalitarian ethics, with the aim to clarify the role of responsibility for choice. In particular, we discuss where liberal egalitarian theories would draw the 'cut' between the responsibility of the state (which is extensive) and the responsibility of the individuals (which is limited but significant). In the third step, we identify a priority setting dilemma where the commonly advocated criteria would assign equal priority. Finally, we develop a simple model in order to examine the implications of introducing a well-defined notion of responsibility for choice in a priority-setting dilemma of this kind. Results: Liberal egalitarianism holds individuals responsible for choices that affect their health, given that (i) the illness is completely or partly a result of individual behaviour and choice; (ii) the illness is not life-threatening; (iii) the illness does not limit the use of political rights or the exercise of fundamental capabilities; and (iv) the cost of treatment is low relative to the income of the patients. The paper shows how this type of considerations can be used to determine an optimal level of co-payments for diseases even when individual choices cannot be observed directly. Conclusions: It is possible to assign a limited but significant role to individual responsibility in the rationing of health-care resources. The liberal egalitarian argument captures a concern that is not captured by traditional criteria for priorities in health care. It can thus help policy makers in situations where the cost-effectiveness of different alternatives and the severity of the illnesses are approximately the same, or if the society wants to assign some weight to responsibility for choice. It can easily be linked to a system of graduated co-payments, but need not be.

The Future of Moral Theories: Reflecting on Torbjörn Tännsjö’s Book “Setting Health-Care Priorities”

Arhe, 2020

Torbjörn Tännsjö’s monograph “Setting Health-Care Priorities” clearly demonstrates its position in finest details involving case studies. It seems to be an especially valuable assistance, not least for study purposes, for those who are interested in a comprehensive review of plausible moral theories and the practice of fair resource distribution in the field of healthcare. The author’s approach suggests engagement of the most applicable moral theories attempting to solve the important problem of sharing scarce and deficit resources in the healthcare. The book doesn’t aim for developing a single correct and effective moral theory for fair resource sharing, it rather discusses reaching a consensus regarding distribution decisions based on thoroughly reviewed theories. The appeal to Population Ethics in the present paper emphasizes the difference between patient-centered approach in the situation of limited medical resources and distribution of resources among the population in general...

The Political Ethics of Health

Les ateliers de l'éthique, 2010

This paper seeks to provide an overview of some of the main areas of debate that have emerged in recent years at the interface between theories of justice and health care. First, the paper considers various positions as to what the index of justice with respect to health ought to be. It warns on practical and principled grounds against conceptual inflation of the notion of "health" as it appears in theories of distributive justice. Second, it considers how various standards according to which goods ought to be distributed in a just society apply to debates within health care.

Just Health (Care): Social Justice, Health and the Common Good

Zeitschrift für Wirtschafts- und Unternehmensethik 13.1 (2012): 31-49.

The answer to the question of how to deal with the widening gap between the growing costs of health (care) and necessarily limited health (care) resources in a just fashion, heavily depends on what we take the term ‘just’, to signify. This article is meant to offer a perspective on the topic of just health (care) which takes the idea of justice as virtue seriously by embedding it in the context of its original explication, namely an onto-teleological philosophy which takes (social) justice to be about claim-rights (as well as their corresponding duties) and the common good. This article is, however, not meant to provide ready-made answers or a discussion of the arguments featuring in the contemporary debate about health (care) prioritisation and/or rationing. It rather takes up the cudgels on behalf of the concept of the common good and reminds us of the fact that if we want to talk about (social) justice and just health (care) we cannot do so without also talking about the common good.

Equity in health care

Cuadernos de bioética : revista oficial de la Asociación Española de Bioética y Ética Médica

It has long been known that a segment of the population enjoys distinctly better health status and higher quality of health care than others. To solve this problem, prioritization is unavoidable, and the question is how priorities should be set. Rational priority setting would seek equity amongst the whole population, the extent to which people receive equal care for equal needs. Equity in health care is an ethical imperative not only because of the intrinsic worth of good health, or the value that society places on good health, but because, without good health, people would be unable to enjoy life's other sources of happiness. This paper also argues the importance of the health care's efficiency, but at the same time, it highlights how any innovation and rationalization undertaken in the provision of the health system should be achieved from the consideration of human dignity, making the person prevail over economic criteria. Therefore, the underlying principles on which th...

Justice is a Virtue both in and out of Healthcare

Irish Theological Quarterly, 1998

Most considerations of justice in healthcare focus on the allocation of resources. The concerns of resource allocation are important and require careful analysis in order to guarantee that justice is maintained. However, a healthcare system that is guided by rights and access issues is confounded or fails when the rights of one person conflict with the rights of another. Thus, justice, as a legal injunction, attempts to distribute healthcare resources in a variety of ways: on a first-come first-served basis, on a lottery draw, on a more or less deserving scale, on a social worth determination, on a cost-benefit ratio, on systemic conditions or on triage estimates. But justice must go beyond the narrow considerations of rights and access to healthcare. Where do we start our conversations about justice in healthcare? In this paper I will look first at the standard interpretations of the principle of justice in healthcare with a view to universal access. Second, I will consider justice as a virtue and how virtue may serve our decision making in matters of healthcare in a more personal and contextual manner than resort to legal formulae. Third, I will propose a virtue theory of just care as an alternative to the utilitarian, contract, principle and feminist theories in biomedical ethics. I will conclude with an exploration of how virtue could respond to Bethany, an infant who both tries and defies medical healthcare practice. 1. Standard Interpretations of Justice 1. Since the publication of their seminal Principles of Biomedical Ethics (1977), now in its fourth edition, Tom L. Beauchamp and James F. Childress defend the cluster principle of "justice ([as] a group of norms for distributing benefits, risks, and costs fairly