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 (...) measures should be adjusted to reflect ethical values. (shrink)

Many philosophers of science have argued that social and ethical values have a significant role to play in core parts of the scientific process. This naturally suggests the following question: when such value choices need to be made, which or whose values should be used? A common answer to this question turns to democratic values—the values of the public or its representatives. I argue that this imposes a morally significant burden on certain scientists, effectively requiring them to advocate for policy (...) positions they strongly disagree with. I conclude by discussing under what conditions this burden might be justified. (shrink)

Recently, a number of philosophers have argued that we can and should “consequentialize” non-consequentialist moral theories, putting them into a consequentialist framework. I argue that these philosophers, usually treated as a group, in fact offer three separate arguments, two of which are incompatible. I show that none represent significant threats to a committed non-consequentialist, and that the literature has suffered due to a failure to distinguish these arguments. I conclude by showing that the failure of the consequentializers’ arguments has implications (...) for disciplines, such as economics, logic, decision theory, and linguistics, which sometimes use a consequentialist structure to represent non-consequentialist ethical theories. (shrink)

This paper presents arguments that challenge what I call the fact/value separability thesis: the idea, roughly, that factual judgements can be made independently of judgements of value. I will look at arguments to the effect that facts and values are entangled in the following areas of the scientific process in economics: theory development, economic concept formation, economic modelling, hypothesis testing, and hypothesis acceptance.

By registering different health benefits on a common scale, CEA allows us to assess the relative social importance of different health care interventions and opens the way for the allocation decisions of health care policy. If it is really to be effective, however, CEA must be recalibrated so that it better reflects some of our widely held beliefs about the merits of different kinds of treatment.

By registering different health benefits on a common scale, CEA allows us to assess the relative social importance of different health care interventions and opens the way for the allocation decisions of health care policy. If it is really to be effective, however, CEA must be recalibrated so that it better reflects some of our widely held beliefs about the merits of different kinds of treatment.

Ethicists widely accept the notion that scientists have moral responsibilities to benefit society at large. The dissemination of scientific information to the public and its political representatives is central to many of the ways in which scientists serve society. Unfortunately, the task of providing information can often give rise to moral quandaries when scientific experts participate in politically charged debates over issues that are fraught with uncertainty. This paper develops a theoretical framework for an “ethics of expertise” (EOE) based on (...) the notion that scientists have responsibilities to provide information in a way that promotes autonomous decision-making on the part of the public and its representatives. Moreover, insofar as the principle of informed consent has developed in biomedical ethics as a way for physicians to promote autonomous decision-making on the part of their patients, this paper suggests that the informed-consent concept may suggest a set of criteria and guidelines that can help scientists to fulfill their similar ethical responsibilities to the public. In order to illustrate how the resulting EOE could provide practical guidance for scientific experts, the paper examines a case study involving the dissemination of information about the low-dose biological effects of toxic chemicals and carcinogens. (shrink)

Some empirical findings seem to show that people value health benefits differently depending on the age of the beneficiary. Health economists and philosophers have offered justifications for these preferences on grounds of both efficiency and equity. In this paper, I examine the most prominent examples of both sorts of justification: the defence of age-weighting in the WHO's global burden of disease studies and the fair innings argument. I argue that neither sort of justification has been worked out in satisfactory form: (...) age should not be taken into account in the framework of the burden of disease measure, and on the most promising formulations of the fair innings argument, it turns out to be merely an indicator of some other factor. I conclude by describing the role of age in theories of justice of healthcare resource allocation. (shrink)

Some empirical findings seem to show that people value health benefits differently depending on the age of the beneficiary. Health economists and philosophers have offered justifications for these preferences on grounds of both efficiency and equity. In this paper, I examine the most prominent examples of both sorts of justification: the defence of age-weighting in the WHO's global burden of disease studies and the fair innings argument. I argue that neither sort of justification has been worked out in satisfactory form: (...) age should not be taken into account in the framework of the burden of disease measure, and on the most promising formulations of the fair innings argument, it turns out to be merely an indicator of some other factor. I conclude by describing the role of age in theories of justice of healthcare resource allocation. (shrink)

This book is a comprehensive account of what it means to try to quantify health in distributing resources for health care. It examines the concept of QALYs which supposedly makes it more accurate to talk about life in terms of both quality and quantity of years lived when referring to health care policy. It offers an elegant new approach to comparing the costs and benefits of medical interventions. Cost-Utility Analysis is a method designed by economists to aid decision makers distribute (...) scarce resources to areas of health care where they will yield the greatest benefits. Erik Nord questions the feasibility of measuring patients' quality of life meaningfully in numerical terms, as CUA presupposes. He presents an alternative approach called cost-value analysis in which representative samples of the general public express preferences between different health-care programs. In this approach, subjects are allowed to include concerns for fairness that go beyond concerns for efficiency of conventional health economics. (shrink)

Universal health coverage (UHC) is at the center of current efforts to strengthen health systems and improve the level and distribution of health and health services. This document is the final report of the WHO Consultative Group on Equity and Universal Health Coverage. The report addresses the key issues of fairness and equity that arise on the path to UHC. As such, the report is relevant for every actor that affects that path and governments in particular, as they are in (...) charge of overseeing and guiding the progress toward UHC. (shrink)

Philosophy of Economics: A Contemporary Introduction is the first systematic textbook in the philosophy of economics. It introduces the epistemological, metaphysical and ethical problems that arise in economics, and presents detailed discussions of the solutions that have been offered. Throughout, philosophical issues are illustrated by and analysed in the context of concrete cases drawn from contemporary economics, the history of economic ideas, and actual economic events. This demonstrates the relevance of philosophy of economics both for the science of economics and (...) for the economy. This text will provide an excellent introduction to the philosophy of economics for students and interested general readers alike. (shrink)

Douglas proposes a new ideal in which values serve an essential function throughout scientific inquiry, but where the role values play is constrained at key points, protecting the integrity and objectivity of science.

When communicating scientific information, experts often face difficult choices about how to promote public understanding while also maintaining an appropriate level of objectivity. We argue that one way for scientists and others involved in communicating scientific information to alleviate these tensions is to pay closer attention to the major frames employed in the contexts in which they work. By doing so, they can ideally employ useful frames while also enabling the recipients of information to “backtrack” to relatively uncontroversial facts and (...) recognize how these frames relate to their own values and perspectives. Important strategies for promoting this sort of backtracking include identifying the weaknesses of particular frames, preventing misunderstanding of them, differentiating well-supported findings from more speculative claims, and acknowledging major alternative frames. (shrink)

Temkin presents a new way of thinking about equality and inequality that challenges the assumptions of philosophers, welfare economists, and others, and has significant implications on both a practical and theoretical level.