About this topic
Summary The allocation of medical 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. Resource allocations are typically driven by two competing factors: 'efficiency' (on the grounds that we should want resources in a social institution like medicine to bring about more benefit rather than less) and 'equality' (on the grounds people can suffer to differing degrees from ill health, and we should have some preference to help those who are worse off). Broadly speaking, many discussions of health care allocation are discussions of how to understand, and how to make commensurable, these two competing considerations. More recently, there has also been a turn towards the idea that since there may be no single, uniquely acceptable way of allocating medical resources, a theory of fair medical allocation must include some discussion of procedural principles, i.e. principles that relate to the process by which actual allocation decisions are made. 
Key works Bognar & Hirose 2014 Daniels 2007
Introductions Cookson & Dolan 2000 Buchanan 1984
Related categories

1 found
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  1. (Draft) The Prospects for Prospect Utilitarianism.Benjamin Davies - manuscript
    Sufficientarianism is a view of distributive justice that places importance on one or more ‘thresholds’, whereby those who are above the threshold have much weaker claims to additional benefits than those below, and may even have no claims at all. Hun Chung has recently argued for a new theory of distributive justice that overcomes two central problems faced by sufficientarianism. Sufficientarianism cannot give intuitively compelling answers to ‘lifeboat cases’, where we can save the lives of some but not all of (...)
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  2. Love Thy Neighbour? Allocating Vaccines in a World of Competing Obligations.Kyle Ferguson & Arthur L. Caplan - forthcoming - Journal of Medical Ethics:medethics-2020-106887.
    Although a safe, effective, and licensed coronavirus vaccine does not yet exist, there is already controversy over how it ought to be allocated. Justice is clearly at stake, but it is unclear what justice requires in the international distribution of a scarce vaccine during a pandemic. Many are condemning ‘vaccine nationalism’ as an obstacle to equitable global distribution. We argue that limited national partiality in allocating vaccines will be a component of justice rather than an obstacle to it. For there (...)
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  3. 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.
  4. Allocation of Scarce Biospecimens for Use in Research.Leah Pierson, Sophia Gibert, Benjamin Berkman, Marion Danis & Joseph Millum - forthcoming - Journal of Medical Ethics:medethics-2019-105766.
    Hundreds of millions of rare biospecimens are stored in laboratories and biobanks around the world. Often, the researchers who possess these specimens do not plan to use them, while other researchers limit the scope of their work because they cannot acquire biospecimens that meet their needs. This situation raises an important and underexplored question: how should scientists allocate biospecimens that they do not intend to use? We argue that allocators should aim to maximise the social value of the research enterprise (...)
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  5. How Can We Decide a Fair Allocation of Healthcare Resources During a Pandemic?Cristina Roadevin & Harry Hill - forthcoming - Journal of Medical Ethics:medethics-2020-106815.
    Whenever the government makes medical resource allocation choices, there will be opportunity costs associated with those choices: some patients will have treatment and live longer, while a different group of patients will die prematurely. Because of this, we have to make sure that the benefits we get from investing in treatment A are large enough to justify the benefits forgone from not investing in the next best alternative, treatment B. There has been an increase in spending and reallocation of resources (...)
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  6. Grow the Pie, or the Resource Shuffle? Commentary on Munthe, Fumagalli and Malmqvist.Ben Davies - 2021 - Journal of Medical Ethics 47 (2):98-99.
    John Rawls’s ‘just savings’ principle is among the better-known attempts to outline how we should balance the claims of the present with the claims of the future generations on resources. A central element of Rawls’s approach involves endorsing a sufficientarian approach, where our central obligation is to ensure ‘the conditions needed to establish and to preserve a just basic structure’.1 This engaging paper by Christian Munthe, Davide Fumagalli and Erik Malmqvist does not explicitly mention Rawls’s work on this issue.2 Still, (...)
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  7. 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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  8. 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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  9. Sustainability Principle for the Ethics of Healthcare Resource Allocation.Christian Munthe, Davide Fumagalli & Erik Malmqvist - 2021 - Journal of Medical Ethics 47 (2):90-97.
    We propose a principle of sustainability to complement established principles used for justifying healthcare resource allocation. We argue that the application of established principles of equal treatment, need, prognosis and cost-effectiveness gives rise to what we call negative dynamics: a gradual depletion of the value possible to generate through healthcare. These principles should therefore be complemented by a sustainability principle, making the prospect of negative dynamics a further factor to consider, and possibly outweigh considerations highlighted by the other principles. We (...)
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  10. 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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  11. Public Perspectives on COVID-19 Vaccine Prioritization.Govind Persad, Ezekiel J. Emanuel, Samantha Sangenito, Aaron Glickman, Steven Phillips & Emily A. Largent - 2021 - JAMA Network Open 4:e217943.
    In this survey study of 4735 US adults, respondents of all demographic and political affiliations agreed with prioritizing COVID-19 vaccine access for health care workers, adults of any age with serious comorbid conditions, frontline workers (eg, teachers and grocery workers), and Black, Hispanic, Native American, and other communities that have been disproportionately affected by COVID-19. Older adult respondents were less likely than younger respondents to list healthy people older than 65 years as 1 of their top 4 priority groups. -/- (...)
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  12. Triage and Justice in an Unjust Pandemic: Ethical Allocation of Scarce Medical Resources in the Setting of Racial and Socioeconomic Disparities.Benjamin Tolchin, Sarah C. Hull & Katherine Kraschel - 2021 - Journal of Medical Ethics 47 (3):200-202.
    Shortages of life-saving medical resources caused by COVID-19 have prompted hospitals, healthcare systems, and governmentsto develop crisis standards of care, including 'triage protocols' to potentially ration medical supplies during the public health emergency. At the same time, the pandemic has highlighted and exacerbated racial, ethnic, and socioeconomic health disparities that together constitute a form of structural racism. These disparities pose a critical ethical challenge in developing fair triage systems that will maximize lives saved without perpetuating systemic inequities. Here we review (...)
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  13. 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 of (...)
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  14. Ethical Allocation of Remdesivir.Parker Crutchfield, Tyler S. Gibb, Michael J. Redinger & William Fales - 2020 - American Journal of Bioethics 20 (7):84-86.
    As the federal government distributed remdesivir to some of the states COVID-19 hit hardest, policymakers scrambled to develop criteria to allocate the drug to their hospitals. Our state, Michigan, was among those states to receive an initial quantity of the drug from the U.S. government. The disparities in burden of disease in Michigan are striking. Detroit has a death rate more than three times the state average. Our recommendation to the state was that it should prioritize the communities that bear (...)
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  15. From Sufficient Health to Sufficient Responsibility.Ben Davies & Julian Savulescu - 2020 - Journal of Bioethical Inquiry 17 (3):423-433.
    The idea of using responsibility in the allocation of healthcare resources has been criticized for, among other things, too readily abandoning people who are responsible for being very badly off. One response to this problem is that while responsibility can play a role in resource allocation, it cannot do so if it will leave those who are responsible below a “sufficiency” threshold. This paper considers first whether a view can be both distinctively sufficientarian and allow responsibility to play a role (...)
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  16. 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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  17. 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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  18. Fair Allocation of Scarce Medical Resources in the Time of Covid-19.Ezekiel J. Emanuel, Govind Persad, Ross Upshur, Beatriz Thome, Michael Parker, Aaron Glickman, Cathy Zhang, Connor Boyle & James P. Phillips - 2020 - New England Journal of Medicine:10.1056/NEJMsb2005114.
    Four ethical values — maximizing benefits, treating equally, promoting and rewarding instrumental value, and giving priority to the worst off — yield six specific recommendations for allocating medical resources in the Covid-19 pandemic: maximize benefits; prioritize health workers; do not allocate on a first-come, first-served basis; be responsive to evidence; recognize research participation; and apply the same principles to all Covid-19 and non–Covid-19 patients.
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  19. 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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  20. Egalitarian Provision of Necessary Medical Treatment.Robert C. Hughes - 2020 - The Journal of Ethics 24 (1):55-78.
    Considerations of autonomy and independence, properly understood, support strictly egalitarian provision of necessary medical treatment. If the financially better-off can purchase access to necessary medical treatments that the financially less well-off cannot purchase without help, then their discretionary power to give or to withhold monetary gifts indirectly gives them the power to make life-and-death or sickness-and-health decisions for others. To prevent private citizens from having this objectionable form of power, government must ensure that citizens’ finances do not affect their access (...)
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  21. Dignity, Autonomy, and Allocation of Scarce Medical Resources During COVID-19.David G. Kirchhoffer - 2020 - Journal of Bioethical Inquiry 17 (4):691-696.
    Ruth Macklin argued that dignity is nothing more than respect for persons or their autonomy. During the COVID-19 pandemic, difficult decisions are being made about the allocation of scarce resources. Respect for autonomy cannot justify rationing decisions. Justice can be invoked to justify rationing. However, this leaves an uncomfortable tension between the principles. Dignity is not a useless concept because it is able to account for why we respect autonomy and for why it can be legitimate to override autonomy in (...)
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  22. 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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  23. Respecting Disability Rights — Toward Improved Crisis Standards of Care.Michelle M. Mello, Govind Persad & Douglas B. White - 2020 - New England Journal of Medicine:DOI: 10.1056/NEJMp2011997.
    We propose six guideposts that states and hospitals should follow to respect disability rights when designing policies for the allocation of scarce, lifesaving medical treatments. Four relate to criteria for decisions. First, do not use categorical exclusions, especially ones based on disability or diagnosis. Second, do not use perceived quality of life. Third, use hospital survival and near-term prognosis (e.g., death expected within a few years despite treatment) but not long-term life expectancy. Fourth, when patients who use ventilators in their (...)
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  24. Global Health Priority-Setting: Beyond Cost-Effectiveness.Ole F. Norheim, Ezekiel J. Emanuel & Joseph Millum (eds.) - 2020 - 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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  25. Disability Law and the Case for Evidence-Based Triage in a Pandemic.Govind Persad - 2020 - Yale Law Journal Forum 130:26-50.
    This Essay explains why model policies proposed or adopted in response to the COVID-19 pandemic that allocate scarce medical resources by using medical evidence to pursue two core goals—saving more lives and saving more years of life—are compatible and consonant with disability law. Disability law, properly understood, permits considering medical evidence about patients’ probability of surviving treatment and the quantity of scarce treatments they will likely use. It also permits prioritizing health workers, and considering patients’ post-treatment life expectancy. These factors, (...)
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  26. A Conceptual Framework for Clearer Ethical Discussions About COVID-19 Response.Govind C. Persad - 2020 - American Journal of Bioethics 20 (7):98-101.
    In this Commentary, I propose an ethical framework for ethical discussions around the allocation of scarce resources in COVID-19 response. The framework incorporates four principles: beneficence (benefiting people by saving lives or years of life), equality, remedying disadvantage, and recognizing past conduct. I then discuss how the framework interacts with ethical constraints against using people as a mere means and against causing death. The commentary closes by criticizing the equation of deontological ethics with random or first-come, first-served allocation and of (...)
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  27. The Case for Valuing Non-Health and Indirect Benefits.Govind Persad & Jessica du Toit - 2020 - In Ole F. Norheim, Ezekiel J. Emanuel & Joseph Millum (eds.), Global Health Priority-Setting: Beyond Cost-Effectiveness. New York, NY, USA: pp. 207-222.
    Health policy is only one part of social policy. Although spending administered by the health sector constitutes a sizeable fraction of total state spending in most countries, other sectors such as education and transportation also represent major portions of national budgets. Additionally, though health is one important aspect of economic and social activity, people pursue many other goals in their social and economic lives. Similarly, direct benefits—those that are immediate results of health policy choices—are only a small portion of the (...)
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  28. Fairly Prioritizing Groups for Access to COVID-19 Vaccines.Govind Persad, Monica E. Peek & Ezekiel J. Emanuel - 2020 - JAMA 1.
    Initial vaccine allocations for the coronavirus disease 2019 (COVID-19) will be limited. It is crucial to assess the ethical values associated with different methods of allocation, as well as important scientific and practical questions. This Viewpoint identifies three ethical values, benefiting people and limiting harm; prioritizing disadvantaged populations; and equal concern for all. It then explains why these values support prioritizing three groups: health care workers; other essential workers and people in high-transmission settings; and people with medical vulnerabilities associated with (...)
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  29. Age Change in Healthcare Settings: A Reply to Lippert-Rasmussen and Petersen.Joona Räsänen - 2020 - Journal of Medical Ethics 46 (9):636-637.
    Lippert-Rasmussen and Petersen discuss my ‘Moral case for legal age change’ in their article ‘Age change, official age and fairness in health’. They argue that in important healthcare settings (such as distributing vital organs for dying patients), the state should treat people on the basis of their chronological age because chronological age is a better proxy for what matters from the point of view of justice than adjusted official age. While adjusted legal age should not be used in deciding who (...)
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  30. The Infectious Diseases Act and Resource Allocation During the COVID-19 Pandemic in Bangladesh.Md Sanwar Siraj, Rebecca Susan Dewey & A. S. M. Firoz Ul Hassan - 2020 - Asian Bioethics Review 12 (4):491-502.
    The Infectious Diseases Act entered into force officially on 14 November 2018 in Bangladesh. The Act is designed to raise awareness of, prevent, control, and eradicate infectious or communicable diseases to address public health emergencies and reduce health risks. A novel coronavirus disease was first identified in Bangladesh on 8 March 2020, and the Ministry of Health and Family Welfare issued a gazette on 23 March, listing COVID-19 as an infectious disease and addressing COVID-19 as a public health emergency. The (...)
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  31. 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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  32. 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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  33. The Fifth Face of Fair Subject Selection: Population Grouping.Tomasz Żuradzki - 2020 - American Journal of Bioethics 20 (2):41-43.
    The article by MacKay and Saylor (2020) claims that the principle of fair subject selection yields conflicting imperatives (e.g. in the case of pregnant women) and should be understood as “a bundle of four distinct sub-principles” (i.e. fair inclusion, burden sharing, opportunity, distribution of third-party risks), each having conflicting normative recommendations (MacKay and Saylor 2020). The authors also offer guidance as to how we should navigate between subprinciples that may conflict with each other. The problem is a crucial one since (...)
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  34. Bursting Bubbles? QALYs and Discrimination.Ben Davies - 2019 - Utilitas 31 (2):191-202.
    The use of Quality-Adjusted Life Years (QALYs) in healthcare allocation has been criticized as discriminatory against people with disabilities. This article considers a response to this criticism from Nick Beckstead and Toby Ord. They say that even if QALYs are discriminatory, attempting to avoid discrimination – when coupled with other central principles that an allocation system should favour – sometimes leads to irrationality in the form of cyclic preferences. I suggest that while Beckstead and Ord have identified a problem, it (...)
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  35. Solidarity and Responsibility in Health Care.Ben Davies & Julian Savulescu - 2019 - Public Health Ethics 12 (2):133-144.
    Some healthcare systems are said to be grounded in solidarity because healthcare is funded as a form of mutual support. This article argues that health care systems that are grounded in solidarity have the right to penalise some users who are responsible for their poor health. This derives from the fact that solidary systems involve both rights and obligations and, in some cases, those who avoidably incur health burdens violate obligations of solidarity. Penalties warranted include direct patient contribution to costs, (...)
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  36. Rawlsian Justice and the Social Determinants of Health.Jayna Fishman & Douglas MacKay - 2019 - Journal of Applied Philosophy 36 (4):608-625.
    In this article, we suggest that the evidence regarding the social determinants of health calls for a deep re‐thinking of our understanding of distributive justice. Focusing on John Rawls's theory of distributive justice in particular, we argue that a full reckoning with the social determinants of health requires a re‐working of Rawls's principles of justice. We argue first that the social bases of health – a Rawlsian conception of the social determinants of health – should be considered a social primary (...)
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  37. 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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  38. Conflicting Demands on a Modern Healthcare Service: Can Rawlsian Justice Provide a Guiding Philosophy for the NHS and Other Socialized Health Services?Zoë Fritz & Caitríona Cox - 2019 - Bioethics 33 (5):609-616.
    We explore whether a Rawlsian approach might provide a guiding philosophy for the development of a healthcare system, in particular with regard to resolving tensions between different groups within it. We argue that an approach developed from some of Rawls’ principles – using his ‘veil of ignorance’ and both the ‘difference’ and ‘just savings’ principles which it generates – provides a compelling basis for policy making around certain areas of conflict. We ask what policies might be made if those making (...)
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  39. First Come, First Served?Tyler M. John & Joseph Millum - 2019 - 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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  40. Medical Crowdfunding, Political Marginalization, and Government Responsiveness: A Reply to Larry Temkin.Alida Liberman - 2019 - Journal of Practical Ethics 7 (1):40-48.
    Larry Temkin draws on the work of Angus Deaton to argue that countries with poor governance sometimes rely on charitable giving and foreign aid in ways that enable them to avoid relying on their own citizens; this can cause them to be unresponsive to their citizens’ needs and thus prevent the long-term alleviation of poverty and other social problems. I argue that the implications of this “lack of government responsiveness argument” (or LOGRA) are both broader and narrower than they might (...)
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  41. 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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  42. What Is Enough? Sufficiency, Justice, and Health: Carina Fourie and Annette Rid, Eds, 2017, Oxford University Press. [REVIEW]Polly Mitchell - 2019 - Journal of Bioethical Inquiry 16 (3):473-475.
    Carina Fourie and Annette Rid’s edited volume What Is Enough? Sufficiency, Justice, and Health comprises fifteen original contributions which explore the possibility of a sufficientarian approach to healthcare priority setting and resource allocation. Sufficientarianism is a well-established theory of distributive justice, which tells us that justice requires that each person has “enough,” and assigns particular importance to a threshold level of goods under which no person must fall. Sufficiency is under-explored as a distributive principle in the healthcare context, and this (...)
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  43. 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.
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  44. 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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  45. Transparency Trade-Offs: Priority Setting, Scarcity, and Health Fairness.Govind Persad - 2019 - In I. Glenn Cohen, Barbara Evans, Holly Lynch & Carmel Shachar (eds.), Transparency in Health and Health Care. New York: Cambridge UP.
    This chapter argues that rather than viewing transparency as a right, we should regard it as a finite resource whose allocation involves tradeoffs. It then argues that those tradeoffs should be resolved by using a multi-principle approach to distributive justice. The relevant principles include maximizing welfare, maximizing autonomy, and giving priority to the worst off. Finally, it examines some of the implications for law of recognizing the tradeoffs presented by transparency proposals.
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  46. Evaluating the Legality of Age-Based Criteria in Health Care: From Nondiscrimination and Discretion to Distributive Justice.Govind Persad - 2019 - Boston College Law Review 60 (3):889-949.
    Recent disputes over whether older people should pay more for health insurance, or receive lower priority for transplantable organs, highlight broader disagreements regarding the legality of using age-based criteria in health care. These debates will likely intensify given the changing age structure of the American population and the turmoil surrounding the financing of American health care. This Article provides a comprehensive examination of the legality and normative desirability of age-based criteria. I defend a distributive justice approach to age-based criteria and (...)
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  47. Will More Organs Save More Lives? Cost‐Effectiveness and the Ethics of Expanding Organ Procurement.Govind Persad - 2019 - Bioethics 33 (6):684-690.
    The assumption that procuring more organs will save more lives has inspired increasingly forceful calls to increase organ procurement. This project, in contrast, directly questions the premise that more organ transplantation means more lives saved. Its argument begins with the fact that resources are limited and medical procedures have opportunity costs. Because many other lifesaving interventions are more cost‐effective than transplantation and compete with transplantation for a limited budget, spending on organ transplantation consumes resources that could have been used to (...)
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  48. 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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  49. 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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  50. 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.