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  1. 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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  2. 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.
  3. 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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  4. 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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  5. 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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  6. 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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  7. 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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  8. 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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  9. 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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  10. 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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  11. 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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  12. 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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  13. 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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  14. 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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  15. 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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  16. 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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  17. 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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  18. Health, Migration and Human Rights.Johannes Kniess - 2020 - Critical Review of International Social and Political Philosophy:1-19.
    Doctors, nurses and midwifes from developing countries migrate to affluent countries in large numbers, often leaving behind severely understaffed healthcare systems. One way to limit this ‘brain drain’ is to restrict the freedom of movement of healthcare workers. Yet this seems to give rise to a conflict of human rights: on the one hand rights to freedom of movement, on the other hand rights to health. By motivating its own account of human rights, this paper argues that the conflict is (...)
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  19. 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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  20. 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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  21. 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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  22. 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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  23. 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: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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  24. 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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  25. 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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  26. 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.
  27. 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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  28. 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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  29. 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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  30. Just Enough Health: Theories of Health Justice by Thomas Schramme. [REVIEW]Mary Jean Walker - 2019 - Journal of Evaluation in Clinical Practice 25 (6):1232-1233.
  31. 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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  32. 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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  33. 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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  34. 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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  35. How to Allocate Scarce Health Resources Without Discriminating Against People with Disabilities.Tyler M. John, Joseph Millum & David Wasserman - 2017 - Economics and Philosophy 33 (2):161-186.
    One widely used method for allocating health care resources involves the use of cost-effectiveness analysis (CEA) to rank treatments in terms of quality-adjusted life-years (QALYs) gained. CEA has been criticized for discriminating against people with disabilities by valuing their lives less than those of non-disabled people. Avoiding discrimination seems to lead to the ’QALY trap’: we cannot value saving lives equally and still value raising quality of life. This paper reviews existing responses to the QALY trap and argues that all (...)
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  36. Calculating Qalys: Liberalism and the Value of Health States.Douglas MacKay - 2017 - Economics and Philosophy 33 (2):259-285.
    The value of health states is often understood to depend on their impact on the goodness of people's lives. As such, prominent health states metrics are grounded in particular conceptions of wellbeing – e.g. hedonism or preference satisfaction. In this paper, I consider how liberals committed to the public justification requirement – the requirement that public officials choose laws and policies that are justifiable to their citizens – should evaluate health states. Since the public justification requirement prohibits public officials from (...)
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  37. Public Values for Health States Versus Societal Valuations of Health Improvements: A Critique of Dan Hausman’s ‘Valuing Health’.Erik Nord - 2017 - Public Health Ethics 10 (2).
    Daniel Hausman’s book ‘Valuing Health’ is a valuable contribution to our understanding of QALYs and DALYs and to moving health economics to adopting a broader perspective than that taken in conventional cost-effectiveness analysis. Hausman’s attempt at constructing a public value table for health states without having recourse to data from population preferences studies is also a fascinating read. But I have serious concerns about his resulting table. Hausman’s views on which dimensions of health a benevolent liberal state should care about (...)
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  38. Fair Resource Allocation to Health Research: Priority Topics for Bioethics Scholarship.Pratt Bridget & A. Hyder Adnan - 2017 - Bioethics 31 (4):454-466.
    This article draws attention to the limited amount of scholarship on what constitutes fairness and equity in resource allocation to health research by individual funders. It identifies three key decisions of ethical significance about resource allocation that research funders make regularly and calls for prioritizing scholarship on those topics – namely, how health resources should be fairly apportioned amongst public health and health care delivery versus health research, how health research resources should be fairly allocated between health problems experienced domestically (...)
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  39. The Public Vs. Private Value of Health, and Their Relationship. [REVIEW]S. Andrew Schroeder - 2017 - Journal of Economic Methodology 24 (3):349-355.
    We sometimes wonder how health is distributed in our society. We may also want to know about the efficiency of different health programmes. Which public measures promise the greatest overall improvements in health? It can be hard to know how to go about answering questions like these, in large part because the varieties of ill health are heterogeneous, as are their consequences. The solution that health economists have long adopted is to appeal to summary or generic measures of health, such (...)
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  40. Value Choices in Summary Measures of Population Health.S. Andrew Schroeder - 2017 - Public Health Ethics 10 (2):176-187.
    Summary measures of health, such as the quality-adjusted life year and disability-adjusted life year, have long been known to incorporate a number of value choices. In this paper, though, I show that the value choices in the construction of such measures extend far beyond what is generally recognized. In showing this, I hope both to improve the understanding of those measures by epidemiologists, health economists and policy-makers, and also to contribute to the general debate about the extent to which such (...)
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  41. Out of Alignment? Limitations of the Global Burden of Disease in Assessing the Allocation of Global Health Aid.Kristin Voigt & Nicholas B. King - 2017 - Public Health Ethics 10 (3):244-256.
    The Global Burden of Disease project quantifies the impact of different health conditions by combining information about morbidity and premature mortality within a single metric, the Disability Adjusted Life Year. One important goal for the GBD project has been to inform decisions about global health priorities. A number of recent studies have used GBD data to argue that global health funding fails to align with the GBD. We argue that these studies’ shared assumption that global health resources should ‘align’ with (...)
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  42. Drinking in the Last Chance Saloon: Luck Egalitarianism, Alcohol Consumption, and the Organ Transplant Waiting List.Andreas Albertsen - 2016 - Medicine, Health Care and Philosophy 19 (2):325-338.
    The scarcity of livers available for transplants forces tough choices upon us. Lives for those not receiving a transplant are likely to be short. One large group of potential recipients needs a new liver because of alcohol consumption, while others suffer for reasons unrelated to their own behaviour. Should the former group receive lower priority when scarce livers are allocated? This discussion connects with one of the most pertinent issues in contemporary political philosophy; the role of personal responsibility in distributive (...)
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  43. Against ‘Saving Lives’: Equal Concern and Differential Impact.Richard Yetter Chappell - 2016 - Bioethics 30 (3):159-164.
    Bioethicists often present ‘saving lives’ as a goal distinct from, and competing with, that of extending lives by as much as possible. I argue that this usage of the term is misleading, and provides unwarranted rhetorical support for neglecting the magnitudes of the harms and benefits at stake in medical allocation decisions, often to the detriment of the young. Equal concern for all persons requires weighting equal interests equally, but not all individuals have an equal interest in ‘life-saving’ treatment.
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  44. Calibrating QALYs to Respect Equality of Persons.Donald Franklin - 2016 - Utilitas 29 (1):1-23.
    Comparative valuation of different policy interventions often requires interpersonal comparability of benefit. In the field of health economics, the metric commonly used for such comparison, quality adjusted life years (QALYs) gained, has been criticized for failing to respect the equality of all persons’ intrinsic worth, including particularly those with disabilities. A methodology is proposed that interprets ‘full quality of life’ as the best health prospect that is achievable for the particular individual within the relevant budget constraint. This calibration is challenging (...)
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  45. Individualised and Personalised QALYs in Exceptional Treatment Decisions.Warwick Heale - 2016 - Journal of Medical Ethics 42 (10):665-671.
    Quality-adjusted life years (QALYs) are used to determine how to allocate resources to health programmes or to treatments within those programmes in order to gain maximum utility from those limited, shared healthcare resources. However, if we use those same population- based QALYs when faced with individual treatment decisions we may act unjustly in relation to that individual or in relation to the wider population. A treatment with a population-based incremental cost-effectiveness ratio beyond our willingness to pay threshold may be denied (...)
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  46. The Economics of Resource Allocation in Health Care: Cost-Utility, Social Value, and Fairness.Andrea Klonschinski - 2016 - Routledge.
    The question of how to allocate scarce medical resources has become an important public policy issue in recent decades. Cost-Utility Analysis is the most commonly used method for determining the allocation of these resources, but this book counters the argument that overcoming its inherent imbalances is simply a question of implementing methodological changes. The Economics of Resource-Allocation in Healthcare represents the first comprehensive analysis of equity weighting in health care resource allocation that offers a fundamental critique of its basic framework. (...)
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  47. Ageing, Justice and Resource Allocation.Tom Walker - 2016 - Journal of Medical Ethics 42 (6):348-352.
    Around the world, the population is ageing in ways that pose new challenges for healthcare providers. To date these have mostly been formulated in terms of challenges created by increasing costs, and the focus has been squarely on life-prolonging treatments. However, this focus ignores the ways in which many older people require life-enhancing treatments to counteract the effects of physical and mental decline. This paper argues that in doing so it misses important aspects of what justice requires when it comes (...)
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  48. Feiring’s Concept of Forward–Looking Responsibility: A Dead End for Responsibility in Healthcare.Andreas Albertsen - 2015 - Journal of Medical Ethics 41 (2):161-164.
    Eli Feiring has developed a concept of forward-looking responsibility in healthcare. On this account, what matters morally in the allocation of scarce healthcare resources is not people's past behaviours but rather their commitment to take on lifestyles that will increase the benefit acquired from received treatment. According to Feiring, this is to be preferred over the backward-looking concept of responsibility often associated with luck egalitarianism. The article critically scrutinises Feiring's position. It begins by spelling out the wider implications of Feiring's (...)
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  49. Tough Luck and Tough Choices: Applying Luck Egalitarianism to Oral Health.Andreas Albertsen - 2015 - Journal of Medicine and Philosophy 40 (3):342-362.
    Luck egalitarianism is often taken to task for its alleged harsh implications. For example, it may seem to imply a policy of nonassistance toward uninsured reckless drivers who suffer injuries. Luck egalitarians respond to such objections partly by pointing to a number of factors pertaining to the cases being debated, which suggests that their stance is less inattentive to the plight of the victims than it might seem at first. However, the strategy leaves some cases in which the attribution of (...)
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  50. QALYs, Euthanasia and the Puzzle of Death.Stephen Barrie - 2015 - Journal of Medical Ethics 41 (8):635-638.
    This paper considers the problems that arise when death, which is a philosophically difficult concept, is incorporated into healthcare metrics, such as the quality-adjusted life year (QALY). These problems relate closely to the debate over euthanasia and assisted suicide because negative QALY scores can be taken to mean that patients would be ‘better off dead’. There is confusion in the literature about the meaning of 0 QALY, which is supposed to act as an ‘anchor’ for the surveyed preferences on which (...)
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