About this topic
Summary Health resource allocation concerns the allocation of resources that contribute to individual and public health. The recognition that health is subject to 'social determinants' that often have more influence than direct healthcare means that this category is much wider than the corresponding category of 'medical resource allocation' (to avoid duplication, papers concerning narrowly medical resources are not included in this category). Some issues are shared between the two categories: as with the allocation of medical resources, the allocation of health resources is a subfield within more general concerns about distributive justice. As such, much discussion of healthcare allocation uses familiar terms and theories from this broader area. However, it is also a subject that has been seen by many to have particular importance, due to the central importance that health plays in human lives. Broader questions include whether health care is 'special' compared with other ways of promoting health; whether allocations of health resources should be concerned with the health only of individuals, or also of groups; whether and how far the promotion of public health warrants compulsion or coercion; and how the demands of national health compete with global health. 
Key works Powers & Faden 2008 Venkatapuram 2011 Eyal et al 2013 
Introductions Hausman 2007 Wilson 2011
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137 found
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1 — 50 / 137
  1. Towards a new model of global health justice: the case of COVID-19 vaccines.Nancy S. Jecker, Caesar A. Atuire & Susan D. Bull - forthcoming - Journal of Medical Ethics.
    This paper questions an exclusively state-centred framing of global health justice and proposes a multilateral alternative. Using the distribution of COVID-19 vaccines to illustrate, we bring to light a broad range of global actors up and down the chain of vaccine development who contribute to global vaccine inequities. Section 1 (Background) presents an overview of moments in which diverse global actors, each with their own priorities and aims, shaped subsequent vaccine distribution. Section 2 (Collective action failures) characterises collective action failures (...)
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  2. How (Not) to Make Trade-Offs Between Health and Other Goods.Antti Kauppinen - forthcoming - Cambridge Quarterly of Healthcare Ethics.
    In the context of a global pandemic, there is good health-based reason for governments to impose various social distancing measures. However, such measures also cause economic and other harms to people at low risk from the virus. In this paper, I examine how to make such trade-offs in a way that is respectfully justifiable to their losers. I argue that existing proposals like using standard QALY (quality-adjusted life-year) valuations or WELLBYs (wellbeing-adjusted life-years) as the currency for trade-offs do not allow (...)
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  3. How Do People Balance Death against Lesser Burdens?Veronika Luptakova & Alex Voorhoeve - forthcoming - In Matthew Lindauer (ed.), Advances in Experimental Political Philosophy.
    Suppose one can fully alleviate either the very large individual health burdens of a first group or instead the significantly lesser burdens of a second group that is at least as numerous. In such cases, the most commonly applied principles for priority setting in health have two characteristics. First, when both groups are equally large, they prioritize alleviating the plight of the more severely burdened. Second, when both groups differ in size, these common principles are unlimited in their aggregation: one (...)
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  4. Special Supplement: What Do We Owe the Elderly? Allocating Social and Health Care Resources.Ruud ter Meulen, Eva Topinková & Daniel Callahan - forthcoming - Hastings Center Report.
  5. Health Research Priority Setting: Do Grant Review Processes Reflect Ethical Principles?Leah Pierson & Joseph Millum - forthcoming - Global Public Health.
    Most public and non-profit organisations that fund health research provide the majority of their funding in the form of grants. The calls for grant applications are often untargeted, such that a wide variety of applications may compete for the same funding. The grant review process therefore plays a critical role in determining how limited research resources are allocated. Despite this, little attention has been paid to whether grant review criteria align with widely endorsed ethical criteria for allocating health research resources. (...)
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  6. Clarifying the Discussion on Prioritization and Discrimination in Healthcare.Joona Räsänen - forthcoming - Cambridge Quarterly of Healthcare Ethics:1-2.
    Discrimination is an important real-life issue that affects many individuals and groups. It is also a fruitful field of study that intersects several disciplines and methods. This Special Section brings together papers on discrimination and prioritization in healthcare from leading scholars in bioethics and closely related fields.
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  7. Reproductive Embryo Editing: Attending to Justice.Inmaculada De Melo-Martín - 2022 - Hastings Center Report 52 (4):26-33.
    The use of genome embryo editing tools in reproduction is often touted as a way to ensure the birth of healthy and genetically related children. Many would agree that this is a worthy goal. The purpose of this paper is to argue that, if we are concerned with justice, accepting such goal as morally appropriate commits one to rejecting the development of embryo editing for reproductive purposes. This is so because safer and more effective means exist that can allow many (...)
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  8. Value assessment frameworks: who is valuing the care in healthcare?Jonathan Anthony Michaels - 2022 - Journal of Medical Ethics 48 (6):419-426.
    Many healthcare agencies are producing evidence-based guidance and policy that may determine the availability of particular healthcare products and procedures, effectively rationing aspects of healthcare. They claim legitimacy for their decisions through reference to evidence-based scientific method and the implementation of just decision-making procedures, often citing the criteria of ‘accountability for reasonableness’; publicity, relevance, challenge and revision, and regulation. Central to most decision methods are estimates of gains in quality-adjusted life-years, a measure that combines the length and quality of survival. (...)
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  9. Should health research funding be proportional to the burden of disease?Joseph Millum - 2022 - Politics, Philosophy and Economics 1 (1):1-24.
    Public funders of health research have been widely criticized on the grounds that their allocations of funding for disease-specific research do not reflect the relative burdens imposed by different diseases. For example, the US National Institutes of Health spends a much greater fraction of its budget on HIV/AIDS research and a much smaller fraction on migraine research than their relative contribution to the US burden of disease would suggest. Implicit in this criticism is a normative claim: Insofar as the scientific (...)
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  10. Sustainable healthcare resource allocation, grounding theories and operational principles: response to our commentators.Christian Munthe, Davide Fumagalli & Erik Malmqvist - 2022 - Journal of Medical Ethics 48 (1):38-38.
    We proposed adding a sustainability principle to the operational ethical principles guiding public healthcare resources allocation decisions. All our commentators acknowledge our core message: healthcare needs to pay attention to the future. They also strengthen our proposal by offering support by luck egalitarian and Rawlsian arguments, and helpfully point out ambiguities and gaps requiring attention in the further development of the proposal, and its practical implementation.
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  11. Conflicting Aims and Values in the Application of Smart Sensors in Geriatric Rehabilitation: Ethical Analysis.Christopher Predel, Cristian Timmermann, Frank Ursin, Marcin Orzechowski, Timo Ropinski & Florian Steger - 2022 - JMIR mHealth and uHealth 10 (6):e32910.
    Background: Smart sensors have been developed as diagnostic tools for rehabilitation to cover an increasing number of geriatric patients. They promise to enable an objective assessment of complex movement patterns. -/- Objective: This research aimed to identify and analyze the conflicting ethical values associated with smart sensors in geriatric rehabilitation and provide ethical guidance on the best use of smart sensors to all stakeholders, including technology developers, health professionals, patients, and health authorities. -/- Methods: On the basis of a systematic (...)
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  12. Value choices in European COVID-19 vaccination schedules: how vaccination prioritization differs from other forms of priority setting.Karolina Wiśniowska, Tomasz Żuradzki & Wojciech Ciszewski - 2022 - Journal of Law and the Biosciences 9 (2):lsac026.
    With the limited initial availability of COVID-19 vaccines in the first months of 2021, decision-makers had to determine the order in which different groups were prioritized. Our aim was to find out what normative approaches to the allocation of scarce preventive resources were embedded in the national COVID-19 vaccination schedules. We systematically reviewed and compared prioritization regulations in 27 members of the European Union, the United Kingdom, and Israel. We differentiated between two types of priority categories: groups that have increased (...)
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  13. Understanding Government Decisions to De-fund Medical Services Analyzing the Impact of Problem Frames on Resource Allocation Policies.Mark Embrett & Glen E. Randall - 2021 - Health Care Analysis 29 (1):78-98.
    Many medical services lack robust evidence of effectiveness and may therefore be considered “unnecessary” care. Proactively withdrawing resources from, or de-funding, such services and redirecting the savings to services that have proven effectiveness would enhance overall health system performance. Despite this, governments have been reluctant to discontinue funding of services once funding is in place. The focus of this study is to understand how the framing of an issue or problem influences government decision-making related to de-funding of medical services. To (...)
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  14. Ordeals, women and gender justice.Anca Gheaus - 2021 - Economics and Philosophy 37 (1):8-22.
    Rationing health care by ordeals is likely to have different effects on women and men, and on distinct groups of women. I show how such putative effects of ordeals are relevant to achieving gender justice. I explain why some ordeals may disproportionately set back women’s interest in discretionary time, health and access to health care, and may undermine equality of opportunity for positions of advantage. Some ordeals protect the interests of the worse-off women yet set back the interests of better-off (...)
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  15. Implementation of Tobacco Control Policies in Bangladesh: A Political Economy Analysis.Md Mahmudul Hoque & Riffat Ara Zannat Tama - 2021 - Public Administration Research 10 (2):36-51.
    After ratifying the Framework Convention for Tobacco Control in 2004, Bangladesh enacted anti-tobacco laws, policies, and administrative measures. Evidence suggests that the progress so far has not been significant, and Bangladesh will most likely fail to meet its target to become tobacco-free by 2040. This study undertakes a national-level political economy analysis to explore the dynamics that affect the processes of required tobacco policy reforms and implementation. Based on a desk review of pertinent pieces of literature and key informant interviews, (...)
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  16. Difficult Trade-Offs in Response to COVID-19: The Case for Open and Inclusive Decision-Making.Ole Frithjof Norheim, Joelle Abi-Rached, Liam Kofi Bright, Kristine Baeroe, Octavio Ferraz, Siri Gloppen & Alex Voorhoeve - 2021 - Nature Medicine 27:10-13.
    We argue that deliberative decision-making that is inclusive, transparent and accountable can contribute to more trustworthy and legitimate decisions on difficult ethical questions and political trade-offs during the pandemic and beyond.
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  17. Pushing poverty off limits: quality improvement and the architecture of healthcare values.Guddi Singh, Vikki Entwistle, Alan Cribb & Polly Mitchell - 2021 - BMC Medical Ethics 22 (1):1-13.
    Background: Poverty and social deprivation have adverse effects on health outcomes and place a significant burden on healthcare systems. There are some actions that can be taken to tackle them from within healthcare institutions, but clinicians who seek to make frontline services more responsive to the social determinants of health and the social context of people’s lives can face a range of ethical challenges. We summarise and consider a case in which clinicians introduced a poverty screening initiative into paediatric practice (...)
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  18. Aggregation, Balancing, and Respect for the Claims of Individuals.Bastian Steuwer - 2021 - Utilitas 33 (1):17-34.
    Most non-consequentialists “let the numbers count” when one can save either a lesser or greater number from equal or similar harm. But they are wary of doing so when one can save either a small number from grave harm or instead a very large number from minor harm. Limited aggregation is an approach that reconciles these two commitments. It is motivated by a powerful idea: our decision whom to save should respect each person who has a claim to our help, (...)
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  19. Respect for persons and the allocation of lifesaving healthcare resources.Xavier Symons - 2021 - Bioethics 35 (5):392-399.
    Many ethicists argue that we should respect persons when we distribute resources. Yet it is unclear what this means in practice. For some, the idea of respect for persons is synonymous with the idea of respect for autonomy. Yet a principle of respect for autonomy provides limited guidance for how we should distribute scarce medical interventions. In this article, however, I sketch an alternative conception of respect for persons—one that is based on an ethic of mutual accountability. I draw in (...)
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  20. The Evolving Science of Disorders of Consciousness Calls for an Inclusive Framework for Healthcare Resource Allocation.Jasmine Walter - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):151-153.
    Commentary on "What Justifies the Allocation of Health Care Resources to Patients with Disorders of Consciousness?", Peterson, Aas and Wasserman.
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  21. The ethics of grandfather clauses in healthcare resource allocation.Gry Wester, Leah Zoe Gibson Rand, Christine Lu & Mark Sheehan - 2021 - Bioethics 35 (2):151-160.
    A grandfather clause is a provision whereby an old rule continues to apply to some existing situation while a new rule applies to all future cases. This paper focuses on the use of grandfather clauses in health technology appraisals (HTAs) issued by the National Institute for Health and Care Excellence (NICE) in the United Kingdom. NICE provides evidence‐based guidance on healthcare technologies and public health interventions that influence resource allocation decisions in the National Health Service (NHS) and the broader public (...)
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  22. Assessing the Wellbeing Impacts of the COVID-19 Pandemic and Three Policy Types: Suppression, Control, and Uncontrolled Spread.Matthew D. Adler, Richard Bradley, Maddalena Ferranna, Marc Fleurbaey, James Hammitt & Alex Voorhoeve - 2020 - Thinktank 20 Policy Briefs for the G20 Meeting in Saudi Arabia 2020.
    The COVID-19 crisis has forced a difficult trade-off between limiting the health impacts of the virus and maintaining economic activity. Welfare economics offers tools to conceptualize this trade-off so that policy-makers and the public can see clearly what is at stake. We review four such tools: the Value of Statistical Life (VSL); the Value of Statistical Life Years (VSLYs); Quality-Adjusted Life-Years (QALYs); and social welfare analysis, and argue that the latter are superior. We also discuss how to choose policies that (...)
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  23. COVID-19 and mental health: government response and appropriate measures.Genevieve Bandares-Paulino & Randy A. Tudy - 2020 - Eubios Journal of Asian and International Bioethics 30 (7):378-382.
    As governments around the world imposed lockdowns or stay-at-home measures, people began to feel the stress as time dragged on. There were already reports on some individuals committing suicide. How do governments respond to such a phenomenon? Our main focus is the Philippine government and how it responded to the COVID-19 pandemic. In this paper, we argue that the problem with COVID-19 went forth just dealing with physical health. First, people suffer not just from being infected but the psychological stress (...)
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  24. Pandemic Ethics: 8 Big Questions of COVID-19.Ben Bramble - 2020 - Sydney: Bartleby Books.
    A clear and provocative introduction to the ethics of COVID-19, suitable for university-level students, academics, and policymakers, as well as the general reader. It is also an original contribution to the emerging literature on this important topic. The author has made it available Open Access, so that it can be downloaded and read for free by all those who are interested in these issues. Key features include: -/- A neat organisation of the ethical issues raised by the pandemic. An exploration (...)
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  25. Disability, Epistemic Harms, and the Quality-Adjusted Life Year.Laura M. Cupples - 2020 - International Journal of Feminist Approaches to Bioethics 13 (1):46-62.
    Health policymakers employ utility measures to inform resource allocation decisions. They often rely on a conceptual tool called the quality-adjusted life year that discounts the value of years lived in a state of disability relative to years lived in full health. A representative sample of the general public is asked to place values on hypothetical health states as part of a standard gamble or time trade-off task. Policymakers use the resulting values to calculate the number of QALYs gained through particular (...)
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  26. Black Lives in a Pandemic: Implications of Systemic Injustice for End-of-Life Care.Alan Elbaum - 2020 - Hastings Center Report 50 (3):58-60.
    In recent months, Covid‐19 has devastated African American communities across the nation, and a Minneapolis police officer murdered George Floyd. The agents of death may be novel, but the phenomena of long‐standing epidemics of premature black death and of police violence are not. This essay argues that racial health and health care disparities, rooted as they are in systemic injustice, ought to carry far more weight in clinical ethics than they generally do. In particular, this essay examines palliative and end‐of‐life (...)
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  27. An ethical framework for global vaccine allocation.Ezekiel J. Emanuel, Govind Persad, Adam Kern, Allen E. Buchanan, Cecile Fabre, Daniel Halliday, Joseph Heath, Lisa M. Herzog, R. J. Leland, Ephrem T. Lemango, Florencia Luna, Matthew McCoy, Ole F. Norheim, Trygve Ottersen, G. Owen Schaefer, Kok-Chor Tan, Christopher Heath Wellman, Jonathan Wolff & Henry S. Richardson - 2020 - Science 1:DOI: 10.1126/science.abe2803.
    In this article, we propose the Fair Priority Model for COVID-19 vaccine distribution, and emphasize three fundamental values we believe should be considered when distributing a COVID-19 vaccine among countries: Benefiting people and limiting harm, prioritizing the disadvantaged, and equal moral concern for all individuals. The Priority Model addresses these values by focusing on mitigating three types of harms caused by COVID-19: death and permanent organ damage, indirect health consequences, such as health care system strain and stress, as well as (...)
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  28. Disability Rights as a Necessary Framework for Crisis Standards of Care and the Future of Health Care.Laura Guidry-Grimes, Katie Savin, Joseph A. Stramondo, Joel Michael Reynolds, Marina Tsaplina, Teresa Blankmeyer Burke, Angela Ballantyne, Eva Feder Kittay, Devan Stahl, Jackie Leach Scully, Rosemarie Garland-Thomson, Anita Tarzian, Doron Dorfman & Joseph J. Fins - 2020 - Hastings Center Report 50 (3):28-32.
    In this essay, we suggest practical ways to shift the framing of crisis standards of care toward disability justice. We elaborate on the vision statement provided in the 2010 Institute of Medicine (National Academy of Medicine) “Summary of Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations,” which emphasizes fairness; equitable processes; community and provider engagement, education, and communication; and the rule of law. We argue that interpreting these elements through disability justice entails a commitment to both (...)
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  29. First Come, First Served?Tyler M. John & Joseph Millum - 2020 - Ethics 130 (2):179-207.
    Waiting time is widely used in health and social policy to make resource allocation decisions, yet no general account of the moral significance of waiting time exists. We provide such an account. We argue that waiting time is not intrinsically morally significant, and that the first person in a queue for a resource does not ipso facto have a right to receive that resource first. However, waiting time can and sometimes should play a role in justifying allocation decisions. First, there (...)
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  30. Harming Children to Benefit Others: A Reply.Heidi Malm & Mark Christopher Navin - 2020 - American Journal of Bioethics 20 (12):W1-W6.
    We are pleased to have received such a varied set of commentaries on our target article, “Pox Parties for Grannies? Chickenpox, Exogenous Boosting, and Harmful Injustices,” and we are thankful for the opportunity to respond to some of them here. We regret that space limitations preclude us from responding to each. In what follows we will begin by addressing commentaries that expand the application of our arguments. We will then correct some seeming misunderstandings about our distinctions, arguments and thesis. We (...)
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  31. Pox Parties for Grannies? Chickenpox, Exogenous Boosting, and Harmful Injustices.Heidi Malm & Mark Christopher Navin - 2020 - American Journal of Bioethics 20 (9):45-57.
    Some societies tolerate or encourage high levels of chickenpox infection among children to reduce rates of shingles among older adults. This tradeoff is unethical. The varicella zoster virus (VZV) causes both chickenpox and shingles. After people recover from chickenpox, VZV remains in their nerve cells. If their immune systems become unable to suppress the virus, they develop shingles. According to the Exogenous Boosting Hypothesis (EBH), a person’s ability to keep VZV suppressed can be ‘boosted’ through exposure to active chickenpox infections. (...)
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  32. Ethical Dimensions of the Global Burden of Disease.Christopher J. L. Murray & S. Andrew Schroeder - 2020 - In Nir Eyal, Samia Hurst, Christopher J. L. Murray, S. Andrew Schroeder & Daniel Wikler (eds.), Measuring the Global Burden of Disease: Philosophical Dimensions. New York, NY, USA: pp. 24-47.
    This chapter suggests that descriptive epidemiological studies like the Global Burden of Disease Study can usefully be divided into four tasks: describing individuals’ health states over time, assessing their health states under a range of counterfactual scenarios, summarizing the information collected, and then packaging it for presentation. The authors show that each of these tasks raises important and challenging ethical questions. They comment on some of the philosophical issues involved in measuring health states, attributing causes to health outcomes, choosing the (...)
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  33. Healthy Nails versus Long Lives: An Analysis of a Dutch Priority Setting Proposal.Alex Voorhoeve - 2020 - In Nir Eyal, Samia A. Hurst, Christopher Murray, S. Andrew Schroeder & Daniel Wikler (eds.), Measuring the Global Burden of Disease: Philosophical Dimensions. New York, NY, USA: pp. 273-292.
    How should governments balance saving people from very large individual disease burdens (such as an early death) against saving them from middling burdens (such as erectile dysfunction) and minor burdens (such as nail fungus)? This chapter considers this question through an analysis of a priority-setting proposal in the Netherlands, on which avoiding a multitude of middling burdens takes priority over saving one person from early death, but no number of very small burdens can take priority over avoiding one death. It (...)
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  34. Setting priorities fairly in response to Covid-19: identifying overlapping consensus and reasonable disagreement.David Wasserman, Govind Persad & Joseph Millum - 2020 - Journal of Law and the Biosciences 1 (1):doi:10.1093/jlb/lsaa044.
    Proposals for allocating scarce lifesaving resources in the face of the Covid-19 pandemic have aligned in some ways and conflicted in others. This paper attempts a kind of priority setting in addressing these conflicts. In the first part, we identify points on which we do not believe that reasonable people should differ—even if they do. These are (i) the inadequacy of traditional clinical ethics to address priority-setting in a pandemic; (ii) the relevance of saving lives; (iii) the flaws of first-come, (...)
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  35. Precision QALYs, Precisely Unjust.Leonard M. Fleck - 2019 - Cambridge Quarterly of Healthcare Ethics 28 (3):439-449.
    Warwick Heale has recently defended the notion of individualized and personalized Quality-Adjusted Life Years in connection with health care resource allocation decisions. Ordinarily, QALYs are used to make allocation decisions at the population level. If a health care intervention costs £100,000 and generally yields only two years of survival, the cost per QALY gained will be £50,000, far in excess of the £30,000 limit per QALY judged an acceptable use of resources within the National Health Service in the United Kingdom. (...)
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  36. Book Review: What time is the 9:20 bus? A Journey to a Meaningful Life, Disability and All, by Lucinda Hage. [REVIEW]Aedan Garcia - 2019 - Canadian Journal of Bioethics / Revue canadienne de bioéthique 2 (2):19-20.
    This book review considers the challenges of raising a child with a developmental disability as seen in the book What time is the 9:20 bus? by Lucinda Hage. Beyond being an emotional and compelling narrative of a mother struggling to navigate Canada’s medical and social support systems, the book is also an excellent introduction to the fields of bioethics, disability ethics, and resource allocation ethics.
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  37. Justice in the Social Distribution of Health.Johannes Kniess - 2019 - Social Theory and Practice 45 (3):397-425.
    How should we think, from the point of view of distributive justice, about inequalities in health and longevity? Norman Daniels’s influential account derives a social duty to reduce health inequalities from Rawls’s principle of fair equality of opportunity. This paper criticises Daniels’s approach and offers an alternative. To the extent that the basic structure of society shapes people’s opportunities to be healthy, we ought to think of ‘the social bases of health’ directly as a Rawlsian primary social good. The paper (...)
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  38. Public health policy in resource allocation: the role of ubuntu ethics in redressing resource disparity between public and private healthcare in South Africa.Nosisa Cynthia Madaka - 2019 - Dissertation, University of Stellenbosch
    This thesis under the title “Public Health Policy in Resource Allocation: the Role of Ubuntu Ethics in Redressing Resource Disparity between Public and Private Healthcare in South Africa” explores health care disparities pertaining to resource allocation between public and private sector. It is of relevance and importance in South Africa where 54% of the population live on less than US$3 per day. Although the government has instituted certain changes aimed at transforming the public health care system, the resource allocation gap (...)
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  39. Utilitarianism and the ethical foundations of cost-effectiveness analysis in resource allocation for global health.Elliot Marseille & James G. Kahn - 2019 - Philosophy, Ethics, and Humanities in Medicine 14 (1):1-7.
    Efficiency as quantified and promoted by cost-effectiveness analysis sometimes conflicts with equity and other ethical values, such as the “rule of rescue” or rights-based ethical values. We describe the utilitarian foundations of cost-effectiveness analysis and compare it with alternative ethical principles. We find that while fallible, utilitarianism is usually superior to the alternatives. This is primarily because efficiency – the maximization of health benefits under a budget constraint – is itself an important ethical value. Other ethical frames may be irrelevant, (...)
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  40. Putting a number on the harm of death.Joseph Millum - 2019 - In Espen Gamlund & Carl Tollef Solberg (eds.), Saving People from the Harm of Death. Oxford University Press. pp. 61-75.
    Donors to global health programs and policymakers within national health systems have to make difficult decisions about how to allocate scarce health care resources. Principled ways to make these decisions all make some use of summary measures of health, which provide a common measure of the value (or disvalue) of morbidity and mortality. They thereby allow comparisons between health interventions with different effects on the patterns of death and ill health within a population. The construction of a summary measure of (...)
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  41. Global Health Priority-Setting: Beyond Cost-Effectiveness.Ole F. Norheim, Ezekiel J. Emanuel & Joseph Millum (eds.) - 2019 - Oxford University Press.
    Global health is at a crossroads. The 2030 Agenda for Sustainable Development has come with ambitious targets for health and health services worldwide. To reach these targets, many more billions of dollars need to be spent on health. However, development assistance for health has plateaued and domestic funding on health in most countries is growing at rates too low to close the financing gap. National and international decision-makers face tough choices about how scarce health care resources should be spent. Should (...)
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  42. Why the Coming Debate Over the QALY and Disability Will be Different.Steven D. Pearson - 2019 - Journal of Law, Medicine and Ethics 47 (2):304-307.
  43. Considering Quality of Life while Repudiating Disability Injustice: A Pathways Approach to Setting Priorities.Govind Persad - 2019 - Journal of Law, Medicine and Ethics 47 (2):294-303.
    This article proposes a novel strategy, one that draws on insights from antidiscrimination law, for addressing a persistent challenge in medical ethics and the philosophy of disability: whether health systems can consider quality of life without unjustly discriminating against individuals with disabilities. It argues that rather than uniformly considering or ignoring quality of life, health systems should take a more nuanced approach. Under the article's proposal, health systems should treat cases where quality of life suffers because of disability-focused exclusion or (...)
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  44. Which values should be built into economic measures?S. Andrew Schroeder - 2019 - Economics and Philosophy 35 (3):521-536.
    Many economic measures are structured to reflect ethical values. I describe three attitudes towards this: maximalism, according to which we should aim to build all relevant values into measures; minimalism, according to which we should aim to keep values out of measures; and an intermediate view. I argue the intermediate view is likely correct, but existing versions are inadequate. In particular, economists have strong reason to structure measures to reflect fixed, as opposed to user-assessable, values. This implies that, despite disagreement (...)
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  45. Social Justice, Equality and Primary Care: (How) Can ‘Big Data’ Help?Kristin Voigt - 2019 - Philosophy and Technology 32 (1):57-68.
    A growing body of research emphasises the role of ‘social determinants of health’ in generating inequalities in health outcomes. How, if at all, should primary care providers respond? In this paper, I want to shed light on this issue by focusing on the role that ‘big data’ might play in allowing primary care providers to respond to the social determinants that affect individual patients’ health. The general idea has been proposed and endorsed by the Institute of Medicine, and the idea (...)
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  46. Experienced Utility or Decision Utility for QALY Calculation? Both.Paige A. Clayton & Douglas P. MacKay - 2018 - Public Health Ethics 11 (1):82-89.
    Policy-makers must allocate scarce resources to support constituents’ health needs. This requires policy-makers to be able to evaluate health states and allocate resources according to some principle of allocation. The most prominent approach to evaluating health states is to appeal to the strength of people’s preferences to avoid occupying them, which we refer to as decision utility metrics. Another approach, experienced utility metrics, evaluates health states based on their hedonic quality. In this article, we argue that although decision utility metrics (...)
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  47. Against lifetime QALY prioritarianism.Anders Herlitz - 2018 - Journal of Medical Ethics 44 (2):109-113.
    Lifetime quality-adjusted life-year (QALY) prioritarianism has recently been defended as a reasonable specification of the prioritarian view that benefits to the worse off should be given priority in health-related priority setting. This paper argues against this view with reference to how it relies on implausible assumptions. By referring to lifetime QALY as the basis for judgments about who is worse off lifetime QALY prioritarianism relies on assumptions of strict additivity, atomism and intertemporal separability of sublifetime attributes. These assumptions entail that (...)
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  48. Is consistency overrated?S. Andrew Schroeder - 2018 - Journal of Medical Ethics 44 (3):199-200.
    In their insightful article, ‘The Disvalue of Death in the Global Burden of Disease’, Solberg et al argue that there is a potential incoherence in the way disability-adjusted life years are calculated. Morbidity is measured in years lived with disability in a way quite unlike the way mortality is measured in years of life lost. This potentially renders them incommensurable, like apples and oranges, and makes their aggregate—DALYs—conceptually unsound. The authors say that it is ‘vital’ to address this problem, that (...)
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  49. Disability discrimination and misdirected criticism of the quality-adjusted life year framework.David G. T. Whitehurst & Lidia Engel - 2018 - Journal of Medical Ethics 44 (11):793-795.
    Whose values should count – those of patients or the general public – when adopting the quality-adjusted life year framework for healthcare decision making is a long-standing debate. Specific disciplines, such as economics, are not wedded to a particular side of the debate, and arguments for and against the use of patient values have been discussed at length in the literature. In 2012, Sinclair proposed an approach, grounded within patient preference theory, which sought to avoid a perceived unfair discrimination against (...)
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  50. The Complicated Relationship of Disability and Well-Being.Stephen M. Campbell & Joseph A. Stramondo - 2017 - Kennedy Institute of Ethics Journal 27 (2):151-184.
    It is widely assumed that disability is typically a bad thing for those who are disabled. Our purpose in this essay is to critique this view and defend a more nuanced picture of the relationship between disability and well-being. We first examine four interpretations of the above view and argue that it is false on each interpretation. We then ask whether disability is thereby a neutral trait. Our view is that most disabilities are neutral in one sense, though we cannot (...)
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