A societal goal to which more and more people in the United States appear to be committed--at least officially--is the assurance of comprehensive health services for every person irrespective of income or geographic location. This paper offers one possible moral justification of the goal. It does so by attempting to apply various standard conceptions of social justice to considerations about health care and to reflect about the reasons why some of the conceptions seem more relevant than others. Several institutional implications (...) are also identified. (shrink)

In QALY-thinking, an activity that takes N people from a bad state (including 'dying') to the state of healthy for X years should have priority over an activity that takes N other people from the same bad state to a state of moderate illness for the same number of years (given equal costs). An empirical study indicates that this view may not be shared by the general public in Norway. Subjects tended to emphasise equality in value of life and in (...) entitlement to treatment rather than level of health after treatment. The relevance of costs per QALY in prioritising between different health care programmes in Norway is thereby brought in to doubt. While the sample in the study is too small to support firm policy conclusions, the results should contribute to an increased interest among health economists in actually measuring people's ethical preferences in matters of prioritising, rather than taking it for granted that their own values are shared by the general public. (shrink)

It is argued that human needs are not facts (properties, states, processes, relations) about people, but are values. The reasons presented for this position are (1) that needs are goal oriented and goals are things people value, (2) that ‘need’ functions as a basic motivational term, and (3) that disagreements about what people need are disagreements in attitude toward, and emotional attachment to, things variously considered to be valuable. If human needs are not facts, then, of course, health or medical (...) needs are not. Viewing health or medical needs as discoverable facts, rather than values, engenders certain difficulties in the following areas of concern: (a) Deciding when surgery is necessary and when unnecessary; (b) Defining the concepts of health and disease; (c) Evaluating some consequences of the development of medical science and technology; and (d) Understanding the alleged conflict between patients' health needs and their human rights. CiteULike Connotea Del.icio.us What's this? (shrink)

A new word has recently entered the British medical vocabulary. What it stands for is neither a disease nor a cure. At least, it is not a cure for a disease in the medical sense. But it could, perhaps, be thought of as an intended cure for a medicosociological disease: namely that of haphazard or otherwise ethically inappropriate allocation of scarce medical resources. What I have in mind is the term ‘QALY’, which is an acronym standing for quality adjusted life (...) year. Just what this means and what it is intended to do I shall explain in due course. Let me first, however, set the scene. (shrink)