This paper challenges traditional views which oppose health economics and medical ethics by arguing that economic assessment is a necessary complement to medical ethics and can help to improve public participation and democratic processes in choices about resource allocation for health care technologies. In support of this argument, four points are emphasized: (1) Most current biomedical ethical debates implicitly deal with economic issues of resource allocation. (2) Clinical decisions, which usually respect the Hippocratic code of ethics, are nevertheless influenced by (...) economic incentives and constraints. (3) Economic assessment is concerned with both efficiency and equity and potential trade-offs between the two, which means that ethical judgements are always embedded in welfare economics. (4) The real debate is not between economics on the one side and medical ethics on the other. Rather it is between different ethical conceptions of social justice and the contrasting approaches they entail to reconciling individual interests and preferences with collective goods and welfare. (shrink)

Despite the prevalence of the terms utilitarianism and utilitarian in the health care and health policy literature, anecdotal evidence suggests that authors are often not fully aware of the diversity of utilitarian theories, their principles, and implications. Further, it seems that authors often categorically reject utilitarianism under the assumption that it violates individual rights. The tendency of act utilitarianism to neglect individual rights is attenuated, however, by the diminishing marginal utility of wealth and the disutility of a protest by those (...) who are disadvantaged. In practice, act utilitarians tend to introduce moral rules and preserve traditional rules. At the same time, the tenability of rule utilitarianism is limited because it ultimately collapses into act utilitarianism or a deontological theory. Negative utilitarianism is a viable utilitarian variant only if we accept complete aversion to suffering, ie, if we disregard any forgone opportunities to increase pleasure. Finally, the adoption of preference utilitarianism requires us to accept the subjectivity of individual claims which may be perceived as unfair. (shrink)

The veil of ignorance has been used often as a tool for recommending what justice requires with respect to the distribution of wealth. We complete Harsanyi's model of the veil of ignorance by appending information permitting objective comparisons among persons. In order to do so, we introduce the concept of objective empathy. We show that the veil-of-ignorance conception of John Harsanyi, so completed, and Ronald Dworkin's, when modelled formally, recommend wealth allocations in conflict with the prominently espoused view that priority (...) should be given to the less able in wealth allocation. We finally argue that the veil of ignorance should be rejected as a tool for discovering what justice requires. (shrink)

Rawls's difference principle, according to which social and economic inequalities are justified only if they achieve the greatest benefit of the least advantaged, has been often interpreted as a maximin-principle, in order to make it fit into the frame of welfare economics. Under this interpretation, however, the difference principle is subject to such grave objections, that it can hardly serve as a principle of justice. In order to avoid these difficulties, modifications of the difference principle have been proposed by Sen (...) and Rae. But these proposals don't lead to acceptable resolutions either. As an alternative, a new interpretation of Rawls's difference principle is proposed, which brings out the reasonable core of this principle and, at the same time, repairs the shortcomings of its earlier interpretations. (shrink)

This article examines the business case for diversity, according to which diversity should be promoted because diverse groups outperform nondiverse groups. Philosophers who defend BCD usually...