Morality and the limits of societal values in health care allocation

In this paper, we consider whether there is a clear moral justification for the proposal that societal value preferences (SVPs) should be included in Cost Effectiveness Analyses (CEA) of health care resource allocations. We argue, first, that proponents of the use of SVPs need to be clear about the...

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Bibliographic Details
Published in:Health economics 2002-04, Vol.11 (3), p.265-273
Main Authors: Walker, Rebecca L., Siegel, Andrew W.
Format: Article
Language:English
Subjects:
Bioethics
Community Participation
Cost benefit analysis
Cost effectiveness
cost effectiveness analysis
cost utility analysis
Cost-Benefit Analysis - methods
Decision Making
Democracy
Health care
Health care access
health care allocation
Health Care Rationing - economics
Health Care Rationing - standards
Health economics
Health Policy
Humans
justice
Morality
Morals
Quality-Adjusted Life Years
Resource allocation
Social conditions & trends
Social Justice
Social Values
societal value preferences
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Summary:In this paper, we consider whether there is a clear moral justification for the proposal that societal value preferences (SVPs) should be included in Cost Effectiveness Analyses (CEA) of health care resource allocations. We argue, first, that proponents of the use of SVPs need to be clear about the relationship between these values and moral principles. In particular, once moral principles are accepted as ruling out some SVPs (such as those that are irrational or revealing prejudice), an account is required of why we need to appeal to SVPs rather than moral principles to determine a just division of health care resources. Secondly, we consider whether an independent moral justification might underwrite the use of SVPs. In various places in the literature the notions of representation, presumed consent and democratic decision making appear to be invoked as candidates for fulfilling this justificatory role. We discuss some problems with each of these justifications in the hope of eliciting a more comprehensive proposal from the proponents of SVPs. We conclude that, although a number of interesting proposals have been made, no compelling justification for including SVPs in CEA has yet been systematically articulated. Copyright © 2002 John Wiley & Sons, Ltd.
ISSN:1057-9230
1099-1050
DOI:10.1002/hec.665