Skip to main content Accessibility help
×
Home

HOW TO ALLOCATE SCARCE HEALTH RESOURCES WITHOUT DISCRIMINATING AGAINST PEOPLE WITH DISABILITIES

  • Tyler M. John (a1), Joseph Millum (a2) and David Wasserman (a3)

Abstract:

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 are problematic. Instead, we argue that adopting a moderate form of prioritarianism avoids the QALY trap and disability discrimination.

Copyright

References

Hide All
Albrecht, G. L. and Devlieger, P. J.. 1999. The disability paradox: high quality of life against all odds. Social Science and Medicine 48: 977988.
Arrow, K. J. 1963. Social Choice and Individual Values (2nd edn). New Haven, CT: Yale University Press.
Barnes, E. 2009. Disability, minority, and difference. Journal of Applied Philosophy 26: 337355.
Barnes, E. 2014. Valuing disability, causing disability. Ethics 125: 88113.
Beckstead, N. 2013. On the Overwhelming Importance of Shaping the Far Future (Dissertation).
Beckstead, N. and Ord, T.. 2013. Rationing and rationality: the cost of avoiding discrimination. In Inequalities in Health: Concepts, Measures, and Ethics, ed. Eyal, N., Hurst, S., Norheim, O. and Wikler, D., 232239. Oxford: Oxford University Press.
Bognar, G. 2010. Does cost effectiveness analysis unfairly discriminate against people with disabilities? Journal of Applied Philosophy 27: 394408.
Brazier, J. 2005. Evaluating the 'disability paradox' in conjunction with resource allocation. Virtual Mentor 7.
Brock, D. 2006. Ethical issues in the use of cost effectiveness analysis for the prioritization of health care resources. In Public Health, Ethics, and Equity, ed. Anand, S., Peter, F. & Sen, A., 201224. Oxford: Oxford University Press.
Brock, D. 2009. Cost-effectiveness and disability discrimination. Economics and Philosophy 25: 2747.
Broome, J. 1990. Rationality and the sure-thing principle. In Thoughtful Economic Man, ed. Meeks, G., 74102. Cambridge: Cambridge University Press.
Broome, J. 1991. Weighing Goods: Equality, Uncertainty and Time. Oxford: Blackwell.
Broome, J. 2002. Measuring the burden of disease by aggregating well-being. In Summary Measures of Population Health: Concepts, Ethics, Measurement and Applications, ed. Murray, C. J., Salomon, J. A., Mathers, C. and Lopez, A. D., 91113. Geneva: World Health Organization.
Broome, J. 2004. Weighing Lives. Oxford: Oxford University Press.
Buchak, L. 2013. Risk and Rationality. Oxford: Oxford University Press.
Dorsey, D. 2009. Headaches, lives and value. Utilitas 21: 3758.
Fleurbaey, M., Tungoddena, B. and Vallentyne, P.. 2009. On the possibility of nonaggregative priority for the worst off. Social Philosophy and Policy 26: 258285.
Gustafsson, J. E. 2010. A money-pump for acyclic intransitive preferences. Dialectica 64: 251257.
Harris, J. 1987. QALYfying the value of life. Journal of Medical Ethics 13: 117123.
Harris, J. 1995. Double jeopardy and the veil of ignorance: a reply. Journal of Medical Ethics 21: 151157.
Harsanyi, J. 1975. Nonlinear social welfare functions. Theory and Decision 6: 311332.
Johri, M. and Norheim, O. F.. 2012. Can cost-effectiveness analysis integrate concerns for equity? Systematic review. International Journal of Technology Assessment in Health Care 28: 125132.
Kamm, F. 2009. Aggregation, allocation of scarce resources, and the disabled. Social Philosophy and Policy 26: 148197.
Kamm, F. 2013. Bioethical Prescriptions. Oxford: Oxford University Press.
Lin, M.R., Hwang, H. F., Chung, K. P., Huang, C. and Chen, C. Y.. 2006. Rating scale, standard gamble, and time trade-off for people with traumatic spinal cord injuries. Physical Therapy 86: 337344.
Marinić, M. and Brkljačić, T.. 2008. Love over gold – the correlation of happiness level with some life satisfaction factors between persons with and without physical disability. Journal of Developmental and Physical Disabilities 20: 527540.
National Institute of Health and Clinical Excellence. 2005. Social Value Judgements: Principles for the Development of NICE Guidance. London: NICE.
Norcross, A. 1997. Trading lives for convenience: it's not just for consequentialists. Southwest Philosophical Review 13: 2937.
Norcross, A. 1998a. Great harms from small benefits grow: how death can be outweighed by headaches. Analysis 58: 152158.
Norcross, A. 1998b. Speed limits, human lives, and convenience: a reply to ridge. Philosophy and Public Affairs 27: 5964.
Norcross, A. 1999. Comparing harms: headaches and human lives. Philosophy and Public Affairs 26: 135167.
Nord, E., Daniels, N. and Kamlet, M.. 2009. QALYs: some challenges. Value in Health 12: S10–S15.
Ottersen, T., Førde, R., Kakad, M., Kjellevold, A., Melberg, H. O., Moen, A., Ringard, A. and Norheim, O. F.. 2016. A new proposal for priority setting in Norway: open and fair. Health Policy 120: 246251.
Peeters, Y., Smith, D. M., Loewenstein, G. and Ubel, P. A.. 2012. After adversity strikes: predictions, recollections and reality among people experiencing the onset of adverse circumstances. Journal of Happiness Studies 13: 589600.
Quigley, M. and Harris, J.. 2008. Personal or public health. In International Public Health and Ethics, ed. Boylan, M., 1530. New York, NY: Springer Science + Business Media B.V.
Rawls, J. 1971. A Theory of Justice. Cambridge, MA: Harvard University Press.
Sharp, D. and Millum, J.. 2015. Prioritarianism for global health investments: identifying the worst off. Journal of Applied Philosophy. doi: 10.1111/japp.12142.
Singer, P. 1993. Practical Ethics (2nd edn). Cambridge: Cambridge University Press.
Singer, P., McKie, J., Kuhse, H. and Richardson, J.. 1995. Double jeopardy and the use of QALYs in health care allocation. Journal of Medical Ethics 21: 144150.
Temkin, L. 1987. Intransitivity and the mere addition paradox. Philosophy and Public Affairs 16: 138187.
Temkin, L. 1993. Inequality. Oxford: Oxford University Press.
Temkin, L. 1996. A continuum argument for intransitivity. Philosophy and Public Affairs 25: 175210.
Temkin, L. 2012. Rethinking the Good. Oxford: Oxford University Press.
Ubel, P. A., Richardson, J. and Prades, J. P.. 1999. Life-saving treatments and disabilities: are all QALYs created equal? International Journal of Technology Assessment in Health Care 15: 738748.
Ubel, P. A., Nord, E., Gold, M., Menzel, P., Prades, J. L. and Richardson, J.. 2000. Improving value measurement in cost-effectiveness analysis. Medical Care 38: 892901.
Ubel, P. A., Loewenstein, G., Schwarz, N. and Smith, D.. 2005. Misimagining the unimaginable: the disability paradox and health care decision making. Health Psychology 24: S57–62.
Voorhoeve, A. 2014. How should we aggregate competing claims? Ethics 125: 6487.
Voorhoeve, A. and Fleurbaey, M.. 2016. Priority or equality for possible people? Ethics 126: 929954.
Wolff, J. and de-Shalit, A.. 2007. Disadvantage. Oxford: Oxford University Press.

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed