We argue that the economic evaluation of health care (cost–benefit analysis) should respect individual preferences and should incorporate distributional considerations. Relying on individual preferences does not imply subjective welfarism. We propose a particular non-welfarist approach, based on the concept of equivalent income, and show how it helps to define distributional weights. We illustrate the feasibility of our approach with empirical results from a pilot survey.

In evaluating difficult decisions which have a wide social impact, consequentialist ethics offers the most reliable footing. Consequentialism is necessary, for that matter, in order to make room for scientific input which will in turn endeavour to provide accurate and objective predictions of the effects of the decisions in question. In the final analysis, we are dealing with value-laden choices and consequentialism should not be, and in fact cannot be, reduced to one specific ethical option. For this reason a political (...) process is necessary for negotiating between the diversity of perspectives. Such a process will proceed in a more structured manner if techniques to make our ethical evaluation more explicit are used, and the furthest that can be gone in this regard is to try to reduce the various effects, as far as is possible, to one common denominator.Socio-economic cost-benefit analysis is often presented as an objective instrument for evaluating governmental decisions. As a matter of fact, however, it departs from a quite specific utilitarian option , and one which is not easy to accept. From this perspective, decisions are evaluated exclusively on the basis of the subjective advantage they bring to individuals in society. The idea of evaluating the various effects involvedin monetary terms can, nevertheless, remain of value, even when we are inclined to resist the technocratic illusion fostered by some supporters of SCBA. Monetary evaluation should certainly not be considered the last word in the discussion. On the contrary, it should be seen as a necessary reference point for the structuring of a wider ethical and political debate.In this paper I have focused exclusively on difficult governmental decisions which have significant economic aspects, i.e. where many of the effects involved can easily be evaluated in market terms. Of course, when this is not the case, the practical advantages of monetary evaluation techniques disappear. When decisions take place at a more personal level, even consequentialism will lose much of its ethical appeal. (shrink)

Social integration is a basic ingredient of any description of a good society. We feel that all people should get the opportunity to realise their full human potential, i.e. to realise their own goals and aspirations. In this paper we claim that this is also part of the responsibility of private sector firms and, therefore, an integral aspect of business ethics. We first argue against the (popular) conviction that the situation of the unemployed is their own responsibility, either because they (...) choose to be unemployed (section 2), or because they choose to be low skilled (section 3). As a consequence, we do not believe that the dismantling of the social security system or the restructuring of the educational system can fully solve the problem of the least skilled in our societies. Nor do we think that the integration of the least skilled is a matter for government policy alone. In section 4 we argue that job creation remains indispensable for a real attack on the problem of social exclusion. In section 5, we highlight the important role of the private sector in this regard. Such job creation will require a lot of effort and imagination at the micro-level of the firm and a lot of creative thinking about how to structure the macrosocial market environment within which private firms operate. (shrink)