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  1. How (Not) to Make Trade-Offs Between Health and Other Goods.Antti Kauppinen - forthcoming - Cambridge Quarterly of Healthcare Ethics.
    In the context of a global pandemic, there is good health-based reason for governments to impose various social distancing measures. However, such measures also cause economic and other harms to people at low risk from the virus. In this paper, I examine how to make such trade-offs in a way that is respectfully justifiable to their losers. I argue that existing proposals like using standard QALY (quality-adjusted life-year) valuations or WELLBYs (wellbeing-adjusted life-years) as the currency for trade-offs do not allow (...)
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  2. How Do People Balance Death Against Lesser Burdens?Veronika Luptakova & Alex Voorhoeve - forthcoming - In Matthew Lindauer (ed.), Advances in Experimental Political Philosophy.
    Suppose one can fully alleviate either the very large individual health burdens of a first group or instead the significantly lesser burdens of a second group that is at least as numerous. In such cases, the most commonly applied principles for priority setting in health have two characteristics. First, when both groups are equally large, they prioritize alleviating the plight of the more severely burdened. Second, when both groups differ in size, these common principles are unlimited in their aggregation: one (...)
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  3. Health Research Priority Setting: Do Grant Review Processes Reflect Ethical Principles?Leah Pierson & Joseph Millum - forthcoming - Global Public Health.
    Most public and non-profit organisations that fund health research provide the majority of their funding in the form of grants. The calls for grant applications are often untargeted, such that a wide variety of applications may compete for the same funding. The grant review process therefore plays a critical role in determining how limited research resources are allocated. Despite this, little attention has been paid to whether grant review criteria align with widely endorsed ethical criteria for allocating health research resources. (...)
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  4. Reproductive Embryo Editing: Attending to Justice.Inmaculada De Melo-Martín - 2022 - Hastings Center Report 52 (4):26-33.
    The use of genome embryo editing tools in reproduction is often touted as a way to ensure the birth of healthy and genetically related children. Many would agree that this is a worthy goal. The purpose of this paper is to argue that, if we are concerned with justice, accepting such goal as morally appropriate commits one to rejecting the development of embryo editing for reproductive purposes. This is so because safer and more effective means exist that can allow many (...)
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  5. Conflicting Aims and Values in the Application of Smart Sensors in Geriatric Rehabilitation: Ethical Analysis.Christopher Predel, Cristian Timmermann, Frank Ursin, Marcin Orzechowski, Timo Ropinski & Florian Steger - 2022 - JMIR mHealth and uHealth 10 (6):e32910.
    Background: Smart sensors have been developed as diagnostic tools for rehabilitation to cover an increasing number of geriatric patients. They promise to enable an objective assessment of complex movement patterns. -/- Objective: This research aimed to identify and analyze the conflicting ethical values associated with smart sensors in geriatric rehabilitation and provide ethical guidance on the best use of smart sensors to all stakeholders, including technology developers, health professionals, patients, and health authorities. -/- Methods: On the basis of a systematic (...)
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  6. Implementation of Tobacco Control Policies in Bangladesh: A Political Economy Analysis.Md Mahmudul Hoque & Riffat Ara Zannat Tama - 2021 - Public Administration Research 10 (2):36-51.
    After ratifying the Framework Convention for Tobacco Control in 2004, Bangladesh enacted anti-tobacco laws, policies, and administrative measures. Evidence suggests that the progress so far has not been significant, and Bangladesh will most likely fail to meet its target to become tobacco-free by 2040. This study undertakes a national-level political economy analysis to explore the dynamics that affect the processes of required tobacco policy reforms and implementation. Based on a desk review of pertinent pieces of literature and key informant interviews, (...)
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  7. Difficult Trade-Offs in Response to COVID-19: The Case for Open and Inclusive Decision-Making.Ole Frithjof Norheim, Joelle Abi-Rached, Liam Kofi Bright, Kristine Baeroe, Octavio Ferraz, Siri Gloppen & Alex Voorhoeve - 2021 - Nature Medicine 27:10-13.
    We argue that deliberative decision-making that is inclusive, transparent and accountable can contribute to more trustworthy and legitimate decisions on difficult ethical questions and political trade-offs during the pandemic and beyond.
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  8. Assessing the Wellbeing Impacts of the COVID-19 Pandemic and Three Policy Types: Suppression, Control, and Uncontrolled Spread.Matthew D. Adler, Richard Bradley, Maddalena Ferranna, Marc Fleurbaey, James Hammitt & Alex Voorhoeve - 2020 - Thinktank 20 Policy Briefs for the G20 Meeting in Saudi Arabia 2020.
    The COVID-19 crisis has forced a difficult trade-off between limiting the health impacts of the virus and maintaining economic activity. Welfare economics offers tools to conceptualize this trade-off so that policy-makers and the public can see clearly what is at stake. We review four such tools: the Value of Statistical Life (VSL); the Value of Statistical Life Years (VSLYs); Quality-Adjusted Life-Years (QALYs); and social welfare analysis, and argue that the latter are superior. We also discuss how to choose policies that (...)
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  9. COVID-19 and Mental Health: Government Response and Appropriate Measures.Genevieve Bandares-Paulino & Randy A. Tudy - 2020 - Eubios Journal of Asian and International Bioethics 30 (7):378-382.
    As governments around the world imposed lockdowns or stay-at-home measures, people began to feel the stress as time dragged on. There were already reports on some individuals committing suicide. How do governments respond to such a phenomenon? Our main focus is the Philippine government and how it responded to the COVID-19 pandemic. In this paper, we argue that the problem with COVID-19 went forth just dealing with physical health. First, people suffer not just from being infected but the psychological stress (...)
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  10. Pandemic Ethics: 8 Big Questions of COVID-19.Ben Bramble - 2020 - Sydney: Bartleby Books.
    A clear and provocative introduction to the ethics of COVID-19, suitable for university-level students, academics, and policymakers, as well as the general reader. It is also an original contribution to the emerging literature on this important topic. The author has made it available Open Access, so that it can be downloaded and read for free by all those who are interested in these issues. Key features include: -/- A neat organisation of the ethical issues raised by the pandemic. An exploration (...)
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  11. An Ethical Framework for Global Vaccine Allocation.Ezekiel J. Emanuel, Govind Persad, Adam Kern, Allen E. Buchanan, Cecile Fabre, Daniel Halliday, Joseph Heath, Lisa M. Herzog, R. J. Leland, Ephrem T. Lemango, Florencia Luna, Matthew McCoy, Ole F. Norheim, Trygve Ottersen, G. Owen Schaefer, Kok-Chor Tan, Christopher Heath Wellman, Jonathan Wolff & Henry S. Richardson - 2020 - Science 1:DOI: 10.1126/science.abe2803.
    In this article, we propose the Fair Priority Model for COVID-19 vaccine distribution, and emphasize three fundamental values we believe should be considered when distributing a COVID-19 vaccine among countries: Benefiting people and limiting harm, prioritizing the disadvantaged, and equal moral concern for all individuals. The Priority Model addresses these values by focusing on mitigating three types of harms caused by COVID-19: death and permanent organ damage, indirect health consequences, such as health care system strain and stress, as well as (...)
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  12. Disability Rights as a Necessary Framework for Crisis Standards of Care and the Future of Health Care.Laura Guidry-Grimes, Katie Savin, Joseph A. Stramondo, Joel Michael Reynolds, Marina Tsaplina, Teresa Blankmeyer Burke, Angela Ballantyne, Eva Feder Kittay, Devan Stahl, Jackie Leach Scully, Rosemarie Garland-Thomson, Anita Tarzian, Doron Dorfman & Joseph J. Fins - 2020 - Hastings Center Report 50 (3):28-32.
    In this essay, we suggest practical ways to shift the framing of crisis standards of care toward disability justice. We elaborate on the vision statement provided in the 2010 Institute of Medicine (National Academy of Medicine) “Summary of Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations,” which emphasizes fairness; equitable processes; community and provider engagement, education, and communication; and the rule of law. We argue that interpreting these elements through disability justice entails a commitment to both (...)
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  13. First Come, First Served?Tyler M. John & Joseph Millum - 2020 - Ethics 130 (2):179-207.
    Waiting time is widely used in health and social policy to make resource allocation decisions, yet no general account of the moral significance of waiting time exists. We provide such an account. We argue that waiting time is not intrinsically morally significant, and that the first person in a queue for a resource does not ipso facto have a right to receive that resource first. However, waiting time can and sometimes should play a role in justifying allocation decisions. First, there (...)
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  14. Healthy Nails Versus Long Lives: An Analysis of a Dutch Priority Setting Proposal.Alex Voorhoeve - 2020 - In Nir Eyal, Samia A. Hurst, Christopher Murray, S. Andrew Schroeder & Daniel Wikler (eds.), Measuring the Global Burden of Disease: Philosophical Dimensions. New York, NY, USA: pp. 273-292.
    How should governments balance saving people from very large individual disease burdens (such as an early death) against saving them from middling burdens (such as erectile dysfunction) and minor burdens (such as nail fungus)? This chapter considers this question through an analysis of a priority-setting proposal in the Netherlands, on which avoiding a multitude of middling burdens takes priority over saving one person from early death, but no number of very small burdens can take priority over avoiding one death. It (...)
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  15. Setting Priorities Fairly in Response to Covid-19: Identifying Overlapping Consensus and Reasonable Disagreement.David Wasserman, Govind Persad & Joseph Millum - 2020 - Journal of Law and the Biosciences 1 (1):doi:10.1093/jlb/lsaa044.
    Proposals for allocating scarce lifesaving resources in the face of the Covid-19 pandemic have aligned in some ways and conflicted in others. This paper attempts a kind of priority setting in addressing these conflicts. In the first part, we identify points on which we do not believe that reasonable people should differ—even if they do. These are (i) the inadequacy of traditional clinical ethics to address priority-setting in a pandemic; (ii) the relevance of saving lives; (iii) the flaws of first-come, (...)
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  16. Putting a Number on the Harm of Death.Joseph Millum - 2019 - In Espen Gamlund & Carl Tollef Solberg (eds.), Saving People from the Harm of Death. Oxford University Press. pp. 61-75.
    Donors to global health programs and policymakers within national health systems have to make difficult decisions about how to allocate scarce health care resources. Principled ways to make these decisions all make some use of summary measures of health, which provide a common measure of the value (or disvalue) of morbidity and mortality. They thereby allow comparisons between health interventions with different effects on the patterns of death and ill health within a population. The construction of a summary measure of (...)
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  17. Considering Quality of Life While Repudiating Disability Injustice: A Pathways Approach to Setting Priorities.Govind Persad - 2019 - Journal of Law, Medicine and Ethics 47 (2):294-303.
    This article proposes a novel strategy, one that draws on insights from antidiscrimination law, for addressing a persistent challenge in medical ethics and the philosophy of disability: whether health systems can consider quality of life without unjustly discriminating against individuals with disabilities. It argues that rather than uniformly considering or ignoring quality of life, health systems should take a more nuanced approach. Under the article's proposal, health systems should treat cases where quality of life suffers because of disability-focused exclusion or (...)
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  18. Which Values Should Be Built Into Economic Measures?S. Andrew Schroeder - 2019 - Economics and Philosophy 35 (3):521-536.
    Many economic measures are structured to reflect ethical values. I describe three attitudes towards this: maximalism, according to which we should aim to build all relevant values into measures; minimalism, according to which we should aim to keep values out of measures; and an intermediate view. I argue the intermediate view is likely correct, but existing versions are inadequate. In particular, economists have strong reason to structure measures to reflect fixed, as opposed to user-assessable, values. This implies that, despite disagreement (...)
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  19. How to Allocate Scarce Health Resources Without Discriminating Against People with Disabilities.Tyler M. John, Joseph Millum & David Wasserman - 2017 - Economics and Philosophy 33 (2):161-186.
    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 (...)
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  20. Calibrating QALYs to Respect Equality of Persons.Donald Franklin - 2016 - Utilitas 29 (1):1-23.
    Comparative valuation of different policy interventions often requires interpersonal comparability of benefit. In the field of health economics, the metric commonly used for such comparison, quality adjusted life years (QALYs) gained, has been criticized for failing to respect the equality of all persons’ intrinsic worth, including particularly those with disabilities. A methodology is proposed that interprets ‘full quality of life’ as the best health prospect that is achievable for the particular individual within the relevant budget constraint. This calibration is challenging (...)
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  21. Rawlsian Justice and Palliative Care.Carl Knight & Andreas Albertsen - 2015 - Bioethics 29 (8):536-542.
    Palliative care serves both as an integrated part of treatment and as a last effort to care for those we cannot cure. The extent to which palliative care should be provided and our reasons for doing so have been curiously overlooked in the debate about distributive justice in health and healthcare. We argue that one prominent approach, the Rawlsian approach developed by Norman Daniels, is unable to provide such reasons and such care. This is because of a central feature in (...)
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  22. Stillbirth Should Be Given Greater Priority on the Global Health Agenda.Zeshan U. Qureshi, Joseph Millum, Hannah Blencowe, Maureen Kelley, Joy E. Lawn, Anthony Costello & Tim Colbourn - 2015 - British Medical Journal 351:h4620.
    Stillbirths are largely excluded from international measures of mortality and morbidity. Zeshan Qureshi and colleagues argue that stillbirth should be higher on the global health agenda.
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  23. Nurse Time as a Scarce Health Care Resource.Donna Dickenson - 1994 - In Geoffrey Hunt (ed.), Ethical issues in nursing. London: Routledge. pp. 207-217.
    For a long time, discussion about scarce health care resource allocation was limited to allocation of medical resources, with the paradigmatic case being kidney transplants. This narrow focus on medical resource prevents us from seeing that there are many cases-- perhaps even the majority--in which time is the real scarce resource, particularly nurse time. What ethical principles should apply to nurse time as a scarce health care resource?
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