- Submit
-
Browse
- All Categories
- Metaphysics and Epistemology
- Value Theory
- Science, Logic, and Mathematics
- Science, Logic, and Mathematics
- Logic and Philosophy of Logic
- Philosophy of Biology
- Philosophy of Cognitive Science
- Philosophy of Computing and Information
- Philosophy of Mathematics
- Philosophy of Physical Science
- Philosophy of Social Science
- Philosophy of Probability
- General Philosophy of Science
- Philosophy of Science, Misc
- History of Western Philosophy
- Philosophical Traditions
- Philosophy, Misc
- Other Academic Areas
- More
Switch to: Citations
References in:
Incommensurability and healthcare priority setting
Philosophical Studies 181 (12):3347-3365 (2024)
Add references
You must login to add references.
|
|
|
The available resources for global health assistance are far outstripped by need. In the face of such scarcity, many people endorse a principle according to which highest priority should be given to the worst off. However, in order for this prioritarian principle to be useful for allocation decisions, policy-makers need to know what it means to be badly off. In this article, we outline a conception of disadvantage suitable for identifying the worst off for the purpose of making health resource (...) |
|
|
Many believe that we ought to save a large number from being permanently bedridden rather than save one from death. Many also believe that we ought to save one from death rather than a multitude from a very minor harm, no matter how large this multitude. I argue that a principle I call “Aggregate Relevant Claims” satisfactorily explains these judgments. I offer a rationale for this principle and defend it against objections. |
|
|
In virtue of what is something a reason for action? That is, what makes a consideration a reason to act? This is a metaphysical or meta-normative question about the grounding of reasons for action. The answer to the grounding question has been traditionally given in ‘pure’, univocal terms. This paper argues that there is good reason to understand the ground of practical normativity as a hybrid of traditional ‘pure’ views. The paper 1) surveys the three leading ‘pure’ answers to the (...) |
|
|
Abstract: The paper provides a general account of value relations. It takes its departure in a special type of value relation, parity, which according to Ruth Chang is a form of evaluative comparability that differs from the three standard forms of comparability: betterness, worseness and equal goodness. Recently, Joshua Gert has suggested that the notion of parity can be accounted for if value comparisons are interpreted as normative assessments of preference. While Gert's basic idea is attractive, the way he develops (...) |
|
|
We shall focus on moral theories that are solely concerned with promoting the benefits (e.g., wellbeing) of individuals and explore the possibility of such theories ascribing some priority to benefits to those who are worse off—without this priority being absolute. Utilitarianism (which evaluates alternatives on the basis of total or average benefits) ascribes no priority to the worse off, and leximin (which evaluates alternatives by giving lexical priority to the worst off, and then the second worst off, and so on) (...) |
|
|
This paper argues for the existence of a fourth positive generic value relation that can hold between two items beyond ‘better than’, ‘worse than’, and ‘equally good’: namely ‘on a par’. |
|
|
This paper argues that cost-effectiveness analysis in the healthcare sector introduces a discrimination risk that has thus far been underappreciated and outlines some approaches one can take toward this. It is argued that appropriate standards used in cost-effectiveness analysis in the healthcare sector fail to always fully determine an optimal option, which entails that cost-effectiveness analysis often leaves decision makers with large sets of permissible options. Larger sets of permissible options increase the role of decision makers’ biases, whims, and prejudices, (...) |
|
|
|
|
|
When thinking about population level healthcare priority setting decisions, such as those made by the National Institute for Health and Care Excellence, good medical ethics requires attention to three main principles of health justice: (1) cost-effectiveness, an aspect of beneficence, (2) non-discrimination, and (3) priority to the worse off in terms of both current severity of illness and lifetime health. Applying these principles requires consideration of the identified patients who benefit from decisions and the unidentified patients who bear the opportunity (...) |
|
|
|
|
|
Ruth Chang has defended a concept of "parity", implying that two items may be evaluatively comparable even though neither item is better than or equally good as the other. This article takes no stand on whether there actually are cases of parity. Its aim is only to make the hitherto somewhat obscure notion of parity more precise, by defining it in terms of the standard value relations. Given certain plausible assumptions, the suggested definiens is shown to state a necessary and (...) |
|
|
Norman Daniels’ theory of justice and health faces a serious practical problem: his theory can ground the special moral importance of health and allows distinguishing just from unjust health inequalities, but it provides little practical guidance for allocating resources when they are especially scarce. Daniels’ solution to this problem is a fair process that he specifies as "accountability for reasonableness". Daniels claims that accountability for reasonableness makes limit-setting decisions in healthcare not only legitimate, but also fair. This paper assesses the (...) |
|
|
This paper is a critique of Norman Daniels' and James Sabin's ‘Accountability for Reasonableness’ framework for making priority-setting decisions in health care in the face of widespread disagreement about values. Accountability for Reasonableness has been rapidly gaining worldwide acceptance, arguably to the point of becoming the dominant paradigm in the field of health policy. The framework attempts to set ground rules for a procedure that ensures that whatever decisions result will be fair, reasonable, and legitimate to the extent that even (...) |
|
|
How should one understand comparisons in which neither of two alternatives is at least as good as the other? Much recent literature on comparability problems focuses on what the appropriate explanation of the phenomenon is. Is it due to vagueness or the possibility of non-conventional comparative relations such as parity? This paper argues that the discussions on how to best explain comparability problems has reached an impasse at which it is hard to make any progress. To advance the discussion we (...) |
|
|
A notorious problem that has recently received increased attention in axiology, normative theory and population ethics is the apparent ubiquity of what can be generally called nondeterminacy. This paper illustrates how nondeterminacy can spawn cyclical rankings. So, accepting that practical reasons can admit of nondeterminacy challenges the widely held idea that ‘better than’ is transitive. As a result, standard approaches to rational choice under nondeterminacy fail to be action-guiding, since in some situations all options are dominated, that is, impermissible according (...) |
|
|
This article analyzes approaches to nondeterminacy that suggest that one can make justified choices when primary criteria fail to fully determine a best alternative by introducing a secondary criterion. It is shown that these approaches risk violating Basic Contraction Consistency. Some ways of adjusting two-step models in order to protect against this are addressed, and it is suggested that proponents of two-step models should adopt formal conditions which qualify what counts as a permissible secondary criterion that resemble supervaluationist conditions that (...) |
|
|
A notorious debate in the ethics of healthcare rationing concerns whether to address rationing decisions with substantial principles or with a procedural approach. One major argument in favour of procedural approaches is that substantial principles are indeterminate so that we can reasonably disagree about how to apply them. To deal with indeterminacy, we need a just decision process. In this paper I argue that it is a mistake to abandon substantial principles just because they are indeterminate. It is true that (...) |
|
|
|
|
|
How should scarce health-related resources be allocated? This paper argues that values that apply to these decisions fail to always fully determine what we should do. Health maximization and allocation-according-to-need are suggested as two values that should be part of a general theory of how to allocate health-related resources. The “small improvement argument” is used to argue that it is implausible that one alternative is always better, worse, or equal to another alternative with respect to these values. Approaches that rely (...) |
|
|
This article shows that introducing the positive comparative relation parity only helps one block so‐called “Spectrum Arguments” in order to avoid their unsavoury implications if one specifies parity in a specific way with respect to its persistence. The article illustrates how parity must both admit of persistency and be weakly non‐persistent for parity to block Spectrum Arguments, and identifies some consequences of that discovery for the general debate on Spectrum Arguments, value theory and comparability problems. |
|
|
The principle of need—the idea that resources should be allocated according to need—is often invoked in priority setting in the health care sector. In this article, I argue that a reasonable principle of need must be indeterminate, and examine three different ways that this can be dealt with: appendicizing the principle with further principles, imposing determinacy, or empowering decision makers. I argue that need must be conceptualized as a composite property composed of at least two factors: health shortfall and capacity (...) |
|
|
This article provides a new argument and a new value-theoretical ground for person-centered care and shared decision making that ascribes to it the role of enabling rational choice in situations involving clinical choice. Rather than referring to good health outcomes and/or ethical grounds such as patient autonomy, it argues that a plausible justification and ground for person-centered care and shared decision making is preservation of rationality in the face of comparative non-determinacy in clinical settings. Often, no alternative treatment will be (...) |
|
|
The spectrum argument purports to show that the better-than relation is not transitive, and consequently that orthodox value theory is built on dubious foundations. The argument works by constructing a sequence of increasingly less painful but more drawn-out experiences, such that each experience in the spectrum is worse than the previous one, yet the final experience is better than the experience with which the spectrum began. Hence the betterness relation admits cycles, threatening either transitivity or asymmetry of the relation. This (...) |
|
|
In some sense, bioethics was built on conflicts. Abortion, physician‐assisted suicide, patients’ demand for autonomy all are staple and contentious issues. And the controversies continue to proliferate. What forum best serves such debates? A look at political theories of democracy can help answer that question. The most promising for bioethics debates are theories that ask citizens and officials to justify any demands for collective action by giving reasons that can be accepted by those who are bound by the action. This (...) |
|
|
The incomparability of two items is thought to pose a problem for making justified choices and for consequentialist theories that rely on comparing states of the world to judge the goodness of a particular course of action. In response, it has been argued that items thought incomparable by one of the three standard relations, ‘better than’, ‘worse than’ and ‘equally good’, are instead comparable by some fourth relation, such as ‘roughly equal’ or ‘on a par’. Against such accounts, this article (...) |
|
|
This article presents an approach to how to make reasonable social choices when independent criteria (e.g., prioritarianism, religious freedom) fail to fully determine what to do. The article outlines different explanations of why independent criteria sometimes fail to fully determine what to do and illustrates how they can still be used to eliminate ineligible alternatives, but it is argued that the independent criteria cannot ground a reasonable social choice in these situations. To complement independent criteria when they fail to fully (...) |
|
|
This article addresses the prioritization questions that arise when people attempt to institutionalize reasonable ethical principles and create guidelines for microlevel decisions. I propose that this instantiates an incommensurability problem, and suggest two different kinds of practical solutions for dealing with this issue. |
|
|
This article argues that values that apply to health care allocation entail the possibility of “spectrum arguments,” and that it is plausible that they often fail to determine a best alternative. In order to deal with this problem, a two-step process is suggested. First, we should identify the Strongly Uncovered Set that excludes all alternatives that are worse than some alternatives and not better in any relevant dimension from the set of eligible alternatives. Because the remaining set of alternatives often (...) |
|
|
Much research aimed at developing measures for normative criteria to guide the assessment of healthcare resource allocation decisions has focused on health maximization, equity concerns and more recently approaches based on health capabilities. However, a widely embraced idea is that health resources should be allocated to meet health needs. Little attention has been given to the principle of need which is often mentioned as an alternative independent criteria that could be used to guide healthcare evaluations. This paper develops a model (...) |
PhilPapers logo by Andrea Andrews and Meghan Driscoll.
This site uses cookies and Google Analytics (see our terms & conditions for details regarding the privacy implications). Use of this site is subject to terms & conditions.
All rights reserved by The PhilPapers Foundation
Server: philpapers-web-6f97f49787-4dlf6 uwo