Hypothetical Choice Approaches to Health Care Allocation

Abstract

The application of hypothetical choice models to questions of health care allocation has become a staple both in philosophical and health policy literatures.¹ However, they have been used to argue for almost every imaginable social policy. Norman Daniels has argued for a right to a decent minimum of health care,² but Allan Gibbard has argued against a right to a decent minimum and for sometimes giving priority to enhancing the lives of the healthy.³ Daniels also has argued for distribution of health care to “protect individuals’ fair share of age-relative normal opportunity range for their society,” even though “pure age rationing” cannot be ruled out in all cases.⁴ The contributors to the Comparative Benefits Modeling Project have defended the allocation of health care according to principles of cost-utility analysis,⁵ whereas Albert Weale has argued for a variety of potentially divergent claims, such as the minimization of mortality and the maximization either of the average length of life or the number of lives saved.⁶ Robert Veatch has argued for a claim to a share of resources sufficient to provide persons with mental retardation with an opportunity for equality of outcome, although other ethical principles limit the scope of these demands.⁷ Margaret Battin has advocated policies for the direct termination of life at the onset of substantial morbidity,⁸ and Dan Brock has argued for devoting no resources to patients in persistent vegetative states, but against any one prudent policy with respect to the moderately demented.⁹ Others, including John Harris and Douglas McLean, have suggested that such models may show little or nothing.¹⁰