The ethics of expanding access to cheaper, less effective treatments

The Lancet:S0140-6736(15)01025-9 (2016)

Govind Persad
University of Denver
This article examines a fundamental question of justice in global health. Is it ethically preferable to provide a larger number of people with cheaper treatments that are less effective (or more toxic), or to restrict treatments to a smaller group to provide a more expensive but more effective or less toxic alternative? We argue that choosing to provide less effective or more toxic interventions to a larger number of people is favored by the principles of utility, equality, and priority for those worst-off. Advocates are mistaken to demand that medical care provided in low-income and middle-income countries should be the same as in high-income countries.
Keywords bioethics  cost-effectiveness  health care  utilitarianism  egalitarianism  prioritarianism
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