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
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
Notes and References
Comments on this chapter have been provided by Tom Beauchamp, David DeGrazia, John Hasnas, Hans-Martin Sass, Robert Veatch, LeRoy Walters, and especially, Ruth Faden. Responsibility for errors remains my own.
Daniels, N. (1985) Just Health Care. Cambridge University Press, Cambridge.
Gibbard, A. (1983) The prospective Pareto Principle and equity of access to health care, in Securing Access to Health Care: The Ethical Implications of Differences in the Availability of Health Services, vol. 2, Appendix G, US Government Printing Office, Washington, DC, p. 174.
Daniels, N. (1988) Am I My Parents’ Keeper? Oxford University Press, New York, pp. 76, 80. (All further references to Daniels are from this book).
The Comparative Benefits Modeling Project (1992) A Framework for Cost-Utility Analysis of Government Health Care Programs. US Government Printing Office, Washington, DC. (hereafter cited as CBMP).
Weale, A. (1979) Statistical lives and the principle of maximum benefit. J. Med. Ethics 5, 185–195.
Veatch, R. M. (1986) The Foundations of Justice: Why the Retarded and the Rest of Us Have Claims to Equality. Oxford University Press, New York.
Baffin, M. P. (1987) Age rationing and the just distribution of health care: is there a duty to die? Ethics 97, 317–340.
Brock, D. W. (1988) Justice and the severely demented elderly, J. Med. Philos. 13, 73–99.
Harris, J. (1988) More and better justice, in Philosophy and Medical Welfare, Bell, J. M. and Mendus, S., eds., Cambridge University Press, New York, pp. 75–96; and MacLean, D. (1986) Risk and consent: philosophical issues for centralized decisions, in Values at Risk, McLean, D., ed., Rowman and Allanheld, Totowa, NJ, pp. 17–30.
Rawls, J. (1971) A Theory of Justice, Harvard University Press, Cambridge, MA, pp. 302–303.
Harsanyi, J. (1982) Morality and the theory of rational behaviour, in Utilitarianism and Beyond, Sen, A. and Williams, B., eds., Cambridge University Press, Cambridge, pp. 39–62.
lbid., 47.
Harsanyi, J. (1977) Non-linear social welfare functions: a rejoinder to Professor Sen, in Foundational Problems in the Special Sciences
Butts, R. E. and Hintikka, J., eds., Reidel, Dordrecht, pp. 294,295. “Daniels, 94.
lbid., 58.
lbid., 61.
lbid., 74.
Ibid., 58.
Ibid., 74.
Ibid., 62.
Ibid., 89.
Resnik, M. (1987) Choices: An Introduction to Decision Theory, University of Minneapolis Press, Minneapolis, MN, pp. 13–16; 40–44.
Daniels, 60.
CBMP, 58,59.
Ibid., 57.
Powers, M. (1992) Efficiency, autonomy, and communal values in health care, Yale Law and Policy Rev. 10, 316–361.
CBMP, 57.
Gibbard, 166.
Broome, J. (1991) Weighing Goods, Basil Blackwell, Oxford, p. 130. 31Berry, B. (1989) Theories of Justice, vol. 1, University of California Press, Berkeley, pp. 334, 335.
See Broome, 159–164.
CBMP, 58.
Ibid.
Rawls, J. (1982) Social unity and primary goods, in Utilitarianism and Beyond, Sen, A. and Williams, B., eds., Cambridge University Press, Cambridge, esp. pp. 167–170.
Gibbard, 165.
The former is reflected in Broome, J. (1988) Good, fairness and QALYs, in Philosophy and Medical Welfare, Bell, J. M. and Mendus, S., eds., Cambridge University Press, New York, p. 66; and in Kappel, K. and Sandoe, P. (1992) QALYS age, and fairness, Bioethics 6, pp. 307,308,311. The latter is reflected in Daniels, 94–95.
Gibbard, A. (1986) Risk and value, in Values at Risk, MacLean, D. ed., Rowman and Allanheld, Totowa, NJ, esp. pp. 101–105; McLean, D. Social values and the distribution of risk, also in Values at Risk, pp. 75–93; and Powers, esp. 353–361.
Slote, M. (1985) Common-Sense Morality and Consequentialism,Routledge and Kegan Paul, London pp. 35–59, 143 (fn 5).
Griffin, J. (1986) Well-Being: Its Meaning, Measurement, and Moral Importance, Clarendon Press, Oxford, pp. 170–185.
Brock, D. W. Justice, health care, and the elderly,“ Philosophy and Public Affairs 18(3), 297–312; and (1988) Justice and the severely demented elderly, J. Med. Philos. 13, 73–99.
Brock, Justice and the severely demented elderly, 93.
Ibid.
Daniels, 95; CBMP, 63.
Daniels, 80.
Brock, Justice and the severely demented elderly, 79–80; and Battin, 322.
Rawls, J. (1980) Kantian constructivism in moral theory: the Dewey lectures 1980, J. Philos. 77, esp. 528–533.
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1995 Springer Science+Business Media New York
About this chapter
Cite this chapter
Powers, M. (1995). Hypothetical Choice Approaches to Health Care Allocation. In: Humber, J.M., Almeder, R.F. (eds) Allocating Health Care Resources. Biomedical Ethics Reviews. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-447-4_6
Download citation
DOI: https://doi.org/10.1007/978-1-59259-447-4_6
Publisher Name: Humana Press, Totowa, NJ
Print ISBN: 978-1-4757-4479-8
Online ISBN: 978-1-59259-447-4
eBook Packages: Springer Book Archive