Many questions concerning health involve values. How well is a health system performing? How should resources be allocated between the health system and other uses or among competing healthrelated uses? How should the costs of health services be distributed among members of a population? Who among those in need of transplants should receive scarce organs? What is the best way to treat particular patients? Although many kinds of expertise bear on these questions, values play a large role in answering them. (...) These values are of many kinds – judgments about how health states contribute to the well-being of individuals depend on views about what is good for a person, whereas judgments about how to share the costs of health care or about how to distribute scarce organs among those in need of transplants depend on theories of fairness. The value judgments that need to be made are not only multifaceted and heterogeneous; they are also controversial. Both the understanding of the questions and the substance of the answers may vary widely from individual to individual and among different groups within countries and across national boundaries. How are these many complicated, difficult and controversial evaluative questions to be answered? This could be a question about who should answer them as well as a question about how they should be answered. There are various possible mechanisms, and there is no reason why the same method should be employed to answer every question. Among the possible methods are (1) moral argument, (2) political deliberation and (3) eliciting preferences or judgments from some group. Included in the third method lie many different techniques of elicitation. For example, one could study attitudes by the use of deliberative (focus) groups, by permitting individual choice in some sort of market or quasi-market, by polling or by voting. These methods of answering evaluative questions are not always incompatible with one another. Moral argument can play a role within political deliberation, deliberation by focus groups, individual market choice, or voting.. (shrink)

This essay considers whether permitting the cost-effectiveness of healthcare to govern its allocation is ethically objectionable on the grounds that it fails to give sufficient weight to the severity of people’s health states. After documenting the popular sentiment that appears to support this criticism, the essay considers how to implement prioritising severity, focusing on Erik Nord’s work. The remainder of the essay scrutinises the ethical arguments supporting policies prioritising severity and challenges those who would prioritise severity to define a notion (...) of severity whose prioritisation they can defend. (shrink)