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  1. Healthcare Priorities: The “Young” and the “Old”.Ben Davies - forthcoming - Cambridge Quarterly of Healthcare Ethics.
    Some philosophers and segments of the public think age is relevant to healthcare priority-setting. One argument for this is based in equity: “Old” patients have had either more of a relevant good than “young” patients or enough of that good and so have weaker claims to treatment. This article first notes that some discussions of age-based priority that focus in this way on old and young patients exhibit an ambiguity between two claims: that patients classified as old should have a (...)
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  2. Clarifying the Discussion on Prioritization and Discrimination in Healthcare.Joona Räsänen - forthcoming - Cambridge Quarterly of Healthcare Ethics:1-2.
    Discrimination is an important real-life issue that affects many individuals and groups. It is also a fruitful field of study that intersects several disciplines and methods. This Special Section brings together papers on discrimination and prioritization in healthcare from leading scholars in bioethics and closely related fields.
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  3. Responsibility and the Recursion Problem.Ben Davies - 2022 - Ratio 35 (2):112-122.
    A considerable literature has emerged around the idea of using ‘personal responsibility’ as an allocation criterion in healthcare distribution, where a person's being suitably responsible for their health needs may justify additional conditions on receiving healthcare, and perhaps even limiting access entirely, sometimes known as ‘responsibilisation’. This discussion focuses most prominently, but not exclusively, on ‘luck egalitarianism’, the view that deviations from equality are justified only by suitably free choices. A superficially separate issue in distributive justice concerns the two–way relationship (...)
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  4. The Prospects for ‘Prospect Utilitarianism’.Ben Davies - 2022 - Utilitas 34 (3):335-343.
    Hun Chung argues for a theory of distributive justice – ‘prospect utilitarianism’ – that overcomes two central problems purportedly faced by sufficientarianism: giving implausible answers in ‘lifeboat cases’, where we can save the lives of some but not all of a group, and failing to respect the axiom of continuity. Chung claims that prospect utilitarianism overcomes these problems, and receives empirical support from work in economics on prospect theory. This article responds to Chung's criticisms of sufficientarianism, showing that they are (...)
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  5. Is Regulatory Innovation Fit for Purpose? A Case Study of Adaptive Regulation for Advanced Biotherapeutics.Giovanni De Grandis - 2022 - Regulation and Governance 16.
    The need to better balance the promotion of scientific and technological innovation with risk management for consumer protection has inspired several recent reforms attempting to make regulations more flexible and adaptive. The pharmaceutical sector has a long, established regulatory tradition, as well as a long history of controversies around how to balance incentives for needed therapeutic innovations and protecting patient safety. The emergence of disruptive biotechnologies has provided the occasion for regulatory innovation in this sector. This article investigates the regulation (...)
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  6. COVID-19 Vaccine Refusal and Fair Allocation of Scarce Medical Resources.Govind Persad & Emily A. Largent - 2022 - JAMA Health Forum 3 (4):e220356.
    When hospitals face surges of patients with COVID-19, fair allocation of scarce medical resources remains a challenge. Scarcity has at times encompassed not only hospital and intensive care unit beds—often reflecting staffing shortages—but also therapies and intensive treatments. Safe, highly effective COVID-19 vaccines have been free and widely available since mid-2021, yet many Americans remain unvaccinated by choice. Should their decision to forgo vaccination be considered when allocating scarce resources? Some have suggested it should, while others disagree. We offer a (...)
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  7. Why We Should Stop Using Animal-Derived Products on Patients Without Their Consent.Daniel Rodger - 2022 - Journal of Medical Ethics 48 (10):702-706.
    Medicines and medical devices containing animal-derived ingredients are frequently used on patients without their informed consent, despite a significant proportion of patients wanting to know if an animal-derived product is going to be used in their care. Here, I outline three arguments for why this practice is wrong. First, I argue that using animal-derived medical products on patients without their informed consent undermines respect for their autonomy. Second, it risks causing nontrivial psychological harm. Third, it is morally inconsistent to respect (...)
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  8. COVID-19 Vaccine Boosters for All Adults: An Optimal U.S. Approach?Ameet Sarpatwari, Ankur Pandya, Emily P. Hyle & Govind Persad - 2022 - Annals of Internal Medicine 175 (2):280–282.
    By 20 October 2021, the U.S. Food and Drug Administration (FDA) had amended its Emergency Use Authorizations for immunocompetent adults who previously received the Pfizer-BioNTech, Moderna, or Johnson & Johnson COVID-19 vaccines. For the 2-dose Pfizer-BioNTech and Moderna vaccines, the FDA permitted a single booster dose for adults aged 65 years or older and adults aged 18 to 64 years at high-risk for severe COVID-19 or at high risk for occupational or institutional COVID-19 exposure. For the single-dose Johnson & Johnson (...)
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  9. ‘Personal Health Surveillance’: The Use of mHealth in Healthcare Responsibilisation.Ben Davies - 2021 - Public Health Ethics 14 (3):268-280.
    There is an ongoing increase in the use of mobile health technologies that patients can use to monitor health-related outcomes and behaviours. While the dominant narrative around mHealth focuses on patient empowerment, there is potential for mHealth to fit into a growing push for patients to take personal responsibility for their health. I call the first of these uses ‘medical monitoring’, and the second ‘personal health surveillance’. After outlining two problems which the use of mHealth might seem to enable us (...)
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  10. Priority, Ethical Principle, and Allocation of Scarce Medical Resources. Di Wu - 2021 - Studies in Dialectics of Nature 11 (37):62-68.
    Aiming at the allocation of scarce medical resources, Immanuel and other scholars have put forward a set of influential ethical values and guiding principles. It assigns the priority of resource allocation to those whose lives can be saved and maximized, those who can bring the greatest instrumental value, and those who are the worse off. For other members of society, random selection under the same conditions is adopted. Following the Rawlsian "lexical order, lexicographical" rule, this priority arrangement requires that the (...)
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  11. What Are the Obligations of Pharmaceutical Companies in a Global Health Emergency?Ezekiel J. Emanuel, Allen Buchanan, Shuk Ying Chan, Cécile Fabre, Daniel Halliday, Joseph Heath, Lisa Herzog, R. J. Leland, Matthew S. McCoy, Ole F. Norheim, Carla Saenz, G. Owen Schaefer, Kok-Chor Tan, Christopher Heath Wellman, Jonathan Wolff & Govind Persad - 2021 - Lancet 398 (10304):1015.
    All parties involved in researching, developing, manufacturing, and distributing COVID-19 vaccines need guidance on their ethical obligations. We focus on pharmaceutical companies' obligations because their capacities to research, develop, manufacture, and distribute vaccines make them uniquely placed for stemming the pandemic. We argue that an ethical approach to COVID-19 vaccine production and distribution should satisfy four uncontroversial principles: optimising vaccine production, including development, testing, and manufacturing; fair distribution; sustainability; and accountability. All parties' obligations should be coordinated and mutually consistent. For (...)
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  12. Obligations in a Global Health Emergency - Authors’ Reply.Ezekiel Emanuel, Cecile Fabre, Lisa M. Herzog, Ole F. Norheim, Govind Persad, G. Owen Schaefer & Kok-Chor Tan - 2021 - Lancet 398 (10316):2072.
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  13. Phantom Premise and a Shape-Shifting Ism: Reply to Hassoun.Kyle Ferguson & Arthur Caplan - 2021 - Journal of Medical Ethics 47 (11).
    In ‘Against vaccine nationalism’, Nicole Hassoun misrepresents our argument, distorts our position and ignores crucial distinctions we present in our article, ‘Love thy neighbor? Allocating vaccines in a world of competing obligations’. She has created a strawman that does not resemble our position. In this reply, we address two features of ‘Against vaccine nationalism’. First, we address a phantom premise. Hassoun misattributes to us a thesis, according to which citizen-directed duties are stronger than noncitizen-directed duties. This thesis is a figment (...)
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  14. Love Thy Neighbour? Allocating Vaccines in a World of Competing Obligations.Kyle Ferguson & Arthur Caplan - 2021 - Journal of Medical Ethics 47 (12):e20-e20.
    Although a safe, effective, and licensed coronavirus vaccine does not yet exist, there is already controversy over how it ought to be allocated. Justice is clearly at stake, but it is unclear what justice requires in the international distribution of a scarce vaccine during a pandemic. Many are condemning ‘vaccine nationalism’ as an obstacle to equitable global distribution. We argue that limited national partiality in allocating vaccines will be a component of justice rather than an obstacle to it. For there (...)
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  15. 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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  16. Against Exclusive Survivalism: Preventing Lost Life and Protecting the Disadvantaged in Resource Allocation.Govind Persad - 2021 - Hastings Center Report 51 (5):47-51.
    When life-saving medical resources are scarce and not everyone can be saved, is the only relevant goal saving the most lives? Or can other factors be considered, at least as tiebreakers, such as how early in life the people we don't save will die or how much future life they are likely to lose? This commentary defends a multiprinciple allocation approach that considers objectives in addition to saving more lives, including preventing early death and preventing harm in the form of (...)
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  17. Fair Allocation of Scarce Therapies for COVID-19.Govind Persad, Monica E. Peek & Seema K. Shah - 2021 - Clinical Infectious Diseases 18:ciab1039.
    The U.S. FDA has issued emergency use authorizations for monoclonal antibodies for non-hospitalized patients with mild or moderate COVID-19 disease and for individuals exposed to COVID-19 as post-exposure prophylaxis. One EUA for an oral antiviral drug, molnupiravir, has also been recommended by FDA’s Antimicrobial Drugs Advisory Committee, and others appear likely in the near future. Due to increased demand because of the Delta variant, the federal government resumed control over the supply and asked states to ration doses. As future variants (...)
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  18. Allocation of Scarce Biospecimens for Use in Research.Leah Pierson, Sophia Gibert, Benjamin Berkman, Marion Danis & Joseph Millum - 2021 - Journal of Medical Ethics 47 (11):740-743.
    Hundreds of millions of rare biospecimens are stored in laboratories and biobanks around the world. Often, the researchers who possess these specimens do not plan to use them, while other researchers limit the scope of their work because they cannot acquire biospecimens that meet their needs. This situation raises an important and underexplored question: how should scientists allocate biospecimens that they do not intend to use? We argue that allocators should aim to maximise the social value of the research enterprise (...)
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  19. The Complex Relationship Between Disability Discrimination and Frailty Scoring.Joel Michael Reynolds, Charles E. Binkley & Andrew Shuman - 2021 - American Journal of Bioethics 21 (11):74-76.
    In "Frailty Triage: Is Rationing Intensive Medical Treatment on the Grounds of Frailty Ethical?," Wilkinson (2021) argues that the use of frailty scores in ICU triage does not necessarily involve discrimination on the basis of disability. In support of this argument, he claims, “it is not the disability per se that the score is measuring – rather it is the underlying physiological and physical vulnerability." While we appreciate the attention Wilkinson explicitly pays to disability in this piece, we find the (...)
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  20. 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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  21. Ethical Allocation of Remdesivir.Parker Crutchfield, Tyler S. Gibb, Michael J. Redinger & William Fales - 2020 - American Journal of Bioethics 20 (7):84-86.
    As the federal government distributed remdesivir to some of the states COVID-19 hit hardest, policymakers scrambled to develop criteria to allocate the drug to their hospitals. Our state, Michigan, was among those states to receive an initial quantity of the drug from the U.S. government. The disparities in burden of disease in Michigan are striking. Detroit has a death rate more than three times the state average. Our recommendation to the state was that it should prioritize the communities that bear (...)
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  22. From Sufficient Health to Sufficient Responsibility.Ben Davies & Julian Savulescu - 2020 - Journal of Bioethical Inquiry 17 (3):423-433.
    The idea of using responsibility in the allocation of healthcare resources has been criticized for, among other things, too readily abandoning people who are responsible for being very badly off. One response to this problem is that while responsibility can play a role in resource allocation, it cannot do so if it will leave those who are responsible below a “sufficiency” threshold. This paper considers first whether a view can be both distinctively sufficientarian and allow responsibility to play a role (...)
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  23. 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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  24. 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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  25. Egalitarian Provision of Necessary Medical Treatment.Robert C. Hughes - 2020 - The Journal of Ethics 24 (1):55-78.
    Considerations of autonomy and independence, properly understood, support strictly egalitarian provision of necessary medical treatment. If the financially better-off can purchase access to necessary medical treatments that the financially less well-off cannot purchase without help, then their discretionary power to give or to withhold monetary gifts indirectly gives them the power to make life-and-death or sickness-and-health decisions for others. To prevent private citizens from having this objectionable form of power, government must ensure that citizens’ finances do not affect their access (...)
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  26. 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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  27. The Case for Valuing Non-Health and Indirect Benefits.Govind Persad & Jessica du Toit - 2020 - In Ole F. Norheim, Ezekiel J. Emanuel & Joseph Millum (eds.), Global Health Priority-Setting: Beyond Cost-Effectiveness. New York, NY, USA: pp. 207-222.
    Health policy is only one part of social policy. Although spending administered by the health sector constitutes a sizeable fraction of total state spending in most countries, other sectors such as education and transportation also represent major portions of national budgets. Additionally, though health is one important aspect of economic and social activity, people pursue many other goals in their social and economic lives. Similarly, direct benefits—those that are immediate results of health policy choices—are only a small portion of the (...)
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  28. Age Change in Healthcare Settings: A Reply to Lippert-Rasmussen and Petersen.Joona Räsänen - 2020 - Journal of Medical Ethics 46 (9):636-637.
    Lippert-Rasmussen and Petersen discuss my ‘Moral case for legal age change’ in their article ‘Age change, official age and fairness in health’. They argue that in important healthcare settings (such as distributing vital organs for dying patients), the state should treat people on the basis of their chronological age because chronological age is a better proxy for what matters from the point of view of justice than adjusted official age. While adjusted legal age should not be used in deciding who (...)
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  29. 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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  30. 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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  31. The Fifth Face of Fair Subject Selection: Population Grouping.Tomasz Żuradzki - 2020 - American Journal of Bioethics 20 (2):41-43.
    The article by MacKay and Saylor (2020) claims that the principle of fair subject selection yields conflicting imperatives (e.g. in the case of pregnant women) and should be understood as “a bundle of four distinct sub-principles” (i.e. fair inclusion, burden sharing, opportunity, distribution of third-party risks), each having conflicting normative recommendations (MacKay and Saylor 2020). The authors also offer guidance as to how we should navigate between subprinciples that may conflict with each other. The problem is a crucial one since (...)
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  32. Bursting Bubbles? QALYs and Discrimination.Ben Davies - 2019 - Utilitas 31 (2):191-202.
    The use of Quality-Adjusted Life Years (QALYs) in healthcare allocation has been criticized as discriminatory against people with disabilities. This article considers a response to this criticism from Nick Beckstead and Toby Ord. They say that even if QALYs are discriminatory, attempting to avoid discrimination – when coupled with other central principles that an allocation system should favour – sometimes leads to irrationality in the form of cyclic preferences. I suggest that while Beckstead and Ord have identified a problem, it (...)
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  33. Medical Crowdfunding, Political Marginalization, and Government Responsiveness: A Reply to Larry Temkin.Alida Liberman - 2019 - Journal of Practical Ethics 7 (1):40-48.
    Larry Temkin draws on the work of Angus Deaton to argue that countries with poor governance sometimes rely on charitable giving and foreign aid in ways that enable them to avoid relying on their own citizens; this can cause them to be unresponsive to their citizens’ needs and thus prevent the long-term alleviation of poverty and other social problems. I argue that the implications of this “lack of government responsiveness argument” (or LOGRA) are both broader and narrower than they might (...)
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  34. 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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  35. Cost-Effectiveness in Animal Health: An Ethical Analysis.Govind Persad - 2019 - In Bob Fischer (ed.), Routledge Handbook of Animal Ethics. New York: Routledge.
    -/- This chapter evaluates the ethical issues that using cost-effectiveness considerations to set animal health priorities might present, and its conclusions are cautiously optimistic. While using cost-effectiveness calculations in animal health is not without ethical pitfalls, these calculations offer a pathway toward more rigorous priority-setting efforts that allow money spent on animal well-being to do more good. Although assessing quality of life for animals may be more challenging than in humans, implementing prioritization based on cost-effectiveness is less ethically fraught.
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  36. Transparency Trade-Offs: Priority Setting, Scarcity, and Health Fairness.Govind Persad - 2019 - In I. Glenn Cohen, Barbara Evans, Holly Lynch & Carmel Shachar (eds.), Transparency in Health and Health Care. New York: Cambridge UP.
    This chapter argues that rather than viewing transparency as a right, we should regard it as a finite resource whose allocation involves tradeoffs. It then argues that those tradeoffs should be resolved by using a multi-principle approach to distributive justice. The relevant principles include maximizing welfare, maximizing autonomy, and giving priority to the worst off. Finally, it examines some of the implications for law of recognizing the tradeoffs presented by transparency proposals.
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  37. 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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  38. Will More Organs Save More Lives? Cost‐Effectiveness and the Ethics of Expanding Organ Procurement.Govind Persad - 2019 - Bioethics 33 (6):684-690.
    The assumption that procuring more organs will save more lives has inspired increasingly forceful calls to increase organ procurement. This project, in contrast, directly questions the premise that more organ transplantation means more lives saved. Its argument begins with the fact that resources are limited and medical procedures have opportunity costs. Because many other lifesaving interventions are more cost‐effective than transplantation and compete with transplantation for a limited budget, spending on organ transplantation consumes resources that could have been used to (...)
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  39. 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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  40. Health(Care) and the Temporal Subject.Ben Davies - 2018 - Les Ateliers de l'Éthique / the Ethics Forum 13 (3):38-64.
    Many assume that theories of distributive justice must obviously take people’s lifetimes, and only their lifetimes, as the relevant period across which we distribute. Although the question of the temporal subject has risen in prominence, it is still relatively underdeveloped, particularly in the sphere of health and healthcare. This paper defends a particular view, “momentary sufficientarianism,” as being an important element of healthcare justice. At the heart of the argument is a commitment to pluralism about justice, where theorizing about just (...)
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  41. Balancing Small Against Large Burdens.Alex Voorhoeve - 2018 - Behavioural Public Policy 2 (1):125-142.
    Common principles for resource allocation in health care can prioritize the alleviation of small health burdens over lifesaving treatment. I argue that there is some evidence that these principles are at odds with a sizable share of public opinion, which holds that saving a life should take priority over any number of cures for minor ailments. I propose two possible explanations for this opinion, one debunking and one vindicatory. I also outline how well-designed surveys and moral inquiry could help decide (...)
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  42. Pharmacogenomic Inequalities: Strategies for Justice in Biomedical Research and Healthcare.Giovanni De Grandis - 2017 - Diametros 51:153-172.
    The paper discusses the possibility that the benefits of pharmacogenomics will not be distributed equally and will create orphan populations. I argue that since these inequalities are not substantially different from those produced by ‘traditional’ drugs and are not generated with the intention to discriminate, their production needs not be unethical. Still, the final result is going against deep-seated moral feelings and intuitions, as well as broadly accepted principles of just distribution of health outcomes and healthcare. I thus propose two (...)
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  43. Dilemmas in Access to Medicines: A Humanitarian Perspective – Authors' Reply.Ezekiel J. Emanuel & Govind Persad - 2017 - Lancet 387 (10073):1008-1009.
    Our Viewpoint argues that expanding access to less effective or more toxic treatments is supported not only by utilitarian ethical reasoning but also by two other ethical frameworks: those that emphasise equality and those that emphasise giving priority to the patients who are worst off. The inadequate resources available for global health reflect not only natural constraints but also unwise social and political choices. However, pitting efforts to reduce inequality and better fund global health against efforts to put available resources (...)
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  44. 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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  45. Resource Allocation, Treatment, Disclosure, and Mitochondrial Replacement Techniques: Some Comments on de Melo-Martin and Harris.César Palacios-gonzález - 2017 - Cambridge Quarterly of Healthcare Ethics 26 (2):278-287.
    Some Comments on de Melo-Martin and Harris.
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  46. Public Preferences About Fairness and the Ethics of Allocating Scarce Medical Interventions.Govind Persad - 2017 - In Meng Li & David Tracer (eds.), Interdisciplinary Perspectives on Fairness, Equity, and Justice. Springer, Cham. pp. 51-65.
    This chapter examines how social- scientific research on public preferences bears on the ethical question of how those resources should in fact be allocated, and explain how social-scientific researchers might find an understanding of work in ethics useful as they design mechanisms for data collection and analysis. I proceed by first distinguishing the methodologies of social science and ethics. I then provide an overview of different approaches to the ethics of allocating scarce medical interventions, including an approach—the complete lives system—which (...)
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  47. Why One Should Count Only Claims with Which One Can Sympathize.Alex Voorhoeve - 2017 - Public Health Ethics 10 (2):148-156.
    When one faces competing claims of varying strength on public resources for health, which claims count? This paper proposes the following answer. One should count, or aggregate, a person’s claim just in case one could sympathize with her desire to prioritize her own claim over the strongest competing claim. It argues that this principle yields appealing case judgments and has a plausible grounding in both sympathetic identification with each person, taken separately, and respect for the person for whom most is (...)
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  48. Against ‘Saving Lives’: Equal Concern and Differential Impact.Richard Yetter Chappell - 2016 - Bioethics 30 (3):159-164.
    Bioethicists often present ‘saving lives’ as a goal distinct from, and competing with, that of extending lives by as much as possible. I argue that this usage of the term is misleading, and provides unwarranted rhetorical support for neglecting the magnitudes of the harms and benefits at stake in medical allocation decisions, often to the detriment of the young. Equal concern for all persons requires weighting equal interests equally, but not all individuals have an equal interest in ‘life-saving’ treatment.
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  49. Are Indirect Benefits Relevant to Health Care Allocation Decisions?Jessica Du Toit & Joseph Millum - 2016 - Journal of Medicine and Philosophy 41 (5):540-557.
    When allocating scarce healthcare resources, the expected benefits of alternative allocations matter. But, there are different kinds of benefits. Some are direct benefits to the recipient of the resource such as the health improvements of receiving treatment. Others are indirect benefits to third parties such as the economic gains from having a healthier workforce. This article considers whether only the direct benefits of alternative healthcare resource allocations are relevant to allocation decisions, or whether indirect benefits are relevant too. First, we (...)
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  50. 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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