There is no way literally to measure health, because health is multi-dimensional, and there is no metric whereby one person who is healthier than a second with respect to one dimension but less healthy with respect to another counts as healthier, less healthy or equally healthy overall. Health analysts instead measure how good or bad health states are in some regard. If these values are measures of health states, then identical health states must have identical values. But in different circumstances, (...) the same health state may have different values. It may be better or worse. Uniform values can nevertheless be assigned to kinds of health states, either as a weighted average of the values of their tokens or as the value of the performance in a standard environment of the capacity the health state constitutes. These uniform values are not well suited for some of the purposes for which summary measures of population health have been intended, and a set of non-evaluative indicators may be an attractive alternative. (shrink)

This paper surveys the current philosophical discussion of the ethics of risk imposition, placing it in the context of relevant work in psychology, economics and social theory. The central philosophical problem starts from the observation that it is not practically possible to assign people individual rights not to be exposed to risk, as virtually all activity imposes some risk on others. This is the ‘problem of paralysis’. However, the obvious alternative theory that exposure to risk is justified when its total (...) benefits exceed its total costs faces the standard distributional challenges of consequentialism. Forms of contractualism have been proposed as a solution, but how exactly such theories can be formulated remains problematic, especially when confronted with the difficult cases of mass, novel, risk such as climate change. (shrink)

This paper surveys the current philosophical discussion of the ethics of risk imposition, placing it in the context of relevant work in psychology, economics and social theory. The central philosophical problem starts from the observation that it is not practically possible to assign people individual rights not to be exposed to risk, as virtually all activity imposes some risk on others. This is the ‘problem of paralysis’. However, the obvious alternative theory that exposure to risk is justified when its total (...) benefits exceed its total costs faces the standard distributional challenges of consequentialism. Forms of contractualism have been proposed as a solution, but how exactly such theories can be formulated remains problematic, especially when confronted with the difficult cases of mass, novel, risk such as climate change. (shrink)

Health care systems across the world are unable to afford the best treatment for all patients in all situations. Choices have to be made. One key ethical issue that arises for health authorities is whether the principle of the “rule of rescue” should be adopted or rejected. According to this principle more funding should be available in order to save lives of identifiable, compared with unidentifiable, individuals. Six reasons for giving such priority to identifiable individuals are considered. All are rejected. (...) It is concluded that the principle of the rule of rescue should not be used in determining the allocation of health resources. (shrink)

BACKGROUND: The availability of costly safety measures against transfusion-transmissible infections forces Western countries to confront difficult ethical questions. How to decide about implementing such measures? When are such decisions justified? As a preliminary to addressing these questions, we assessed which concerns shape actual donor blood safety policymaking in five Western countries. STUDY DESIGN AND METHODS: Our qualitative study involved determining which issues had been discussed in advisory committee meetings and capturing these issues in general categories. Appropriate documents were identified in (...) collaboration with local decision-making experts in Canada, Germany, the Netherlands, the United States, and the United Kingdom. The introduction of hepatitis B virus nucleic acid testing and selected measures against variant Creutzfeldt-Jakob disease, West Nile virus, and Q-fever were chosen as cases representing decision-making on safety measures with high costs and low or uncertain added safety. RESULTS: A broad inventory of concerns was established, including: 1) nine categories of advantages and disadvantages of candidate safety policies; 2) six kinds of difficulties in assessing risks and forecasting the effects of safety policies; 3) 13 decision-making principles; and 4) six kinds of practical barriers hampering the translation of candidate policies into decisions. CONCLUSION: Blood safety policymaking involves a wide variety of competing concerns, and approaches to reconcile these considerations are themselves contested. Developing a systematic decision-making approach requires ethical reflection on, among others, reasonable costs of safety and the value of transparency in public policy. (shrink)

The idea of the rule of rescue is that special weight should be given to protecting lives of assignable individuals in need now even if protecting others in the future would be more cost-effective. How can this be justified? One way to cast the problem is to see it as a conflict between a collectivist approach that emphasizes protecting groups or populations versus an approach that boils down to protecting individuals. This chapter argues that one individual-oriented approach to ethics, namely (...) contractualism, will not succeed in justifying the rule of rescue. A more promising route would instead be to focus on collectivistic values like solidarity. It argues that values like solidarity and community may render support for rescue cases. Yet such arguments are not without problems. Moreover, they have limited relevance to discussions about resource allocation in health care. (shrink)