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Distributing scarce livers: The moral reasoning of the general public

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  • Ubel, Peter A.
  • Loewenstein, George

Abstract

The transplant system has been criticized for not paying enough attention to efficiency in distributing scarce organs. But little research has been done to see how the general public views tradeoffs between efficiency and equity. We surveyed members of the general public to see how they would distribute organs among patients with varying chances of benefiting from them. In addition, we asked subjects to explain their decisions and to tell us about any other information they would have liked in order to make the decisions. We found that the public places a very high value on giving everyone a chance at receiving scarce resources, even if that means a significant decrease in the chance that available organs will save people's lives. Our results raise important questions about whether the aims of outcomes research and cost-effective studies agree with the values of the general public.

Suggested Citation

  • Ubel, Peter A. & Loewenstein, George, 1996. "Distributing scarce livers: The moral reasoning of the general public," Social Science & Medicine, Elsevier, vol. 42(7), pages 1049-1055, April.
    • Handle: RePEc:eee:socmed:v:42:y:1996:i:7:p:1049-1055
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    Cited by:

    1. Paul Dolan & Rebecca Shaw & Aki Tsuchiya & Alan Williams, 2005. "QALY maximisation and people's preferences: a methodological review of the literature," Health Economics, John Wiley & Sons, Ltd., vol. 14(2), pages 197-208, February.
    2. Robson, Matthew & O’Donnell, Owen & Van Ourti, Tom, 2024. "Aversion to health inequality — Pure, income-related and income-caused," Journal of Health Economics, Elsevier, vol. 94(C).
    3. repec:cup:judgdm:v:5:y:2010:i:1:p:11-20 is not listed on IDEAS
    4. Pius Krütli & Thomas Rosemann & Kjell Y Törnblom & Timo Smieszek, 2016. "How to Fairly Allocate Scarce Medical Resources: Ethical Argumentation under Scrutiny by Health Professionals and Lay People," PLOS ONE, Public Library of Science, vol. 11(7), pages 1-18, July.
    5. Smeele, Nicholas V.R. & Chorus, Caspar G. & Schermer, Maartje H.N. & de Bekker-Grob, Esther W., 2023. "Towards machine learning for moral choice analysis in health economics: A literature review and research agenda," Social Science & Medicine, Elsevier, vol. 326(C).
    6. Dolan, Paul & Shaw, Rebecca, 2004. "A note on a discussion group study of public preferences regarding priorities in the allocation of donor kidneys," Health Policy, Elsevier, vol. 68(1), pages 31-36, April.
    7. Joan Costa-i-Font & Frank Cowell, 2019. "Incorporating Inequality Aversion in Health-Care Priority Setting," CESifo Working Paper Series 7503, CESifo.
    8. Dolan, Paul & Robinson, Angela, 2001. "The measurement of preferences over the distribution of benefits: The importance of the reference point," European Economic Review, Elsevier, vol. 45(9), pages 1697-1709, October.
    9. Miqdad Asaria & Joan Costa-Font & Frank Cowell, 2023. "How does exposure to COVID-19 influence health and income inequality aversion?," Social Choice and Welfare, Springer;The Society for Social Choice and Welfare, vol. 61(3), pages 625-647, October.
    10. Benning, Tim M. & Dellaert, Benedict G.C., 2013. "Paying more for faster care? Individuals' attitude toward price-based priority access in health care," Social Science & Medicine, Elsevier, vol. 84(C), pages 119-128.
    11. John McKie & Bradley Shrimpton & Jeff Richardson & Rosalind Hurworth, 2011. "The monetary value of a life year: evidence from a qualitative study of treatment costs," Health Economics, John Wiley & Sons, Ltd., vol. 20(8), pages 945-957, August.
    12. Julie Ratcliffe, 2000. "Public preferences for the allocation of donor liver grafts for transplantation," Health Economics, John Wiley & Sons, Ltd., vol. 9(2), pages 137-148, March.
    13. Paul Dolan & Aki Tsuchiya, 2003. "The person trade‐off method and the transitivity principle: an example from preferences over age weighting," Health Economics, John Wiley & Sons, Ltd., vol. 12(6), pages 505-510, June.
    14. Richardson, Jeff & Sinha, Kompal & Iezzi, Angelo & Maxwell, Aimee, 2012. "Maximising health versus sharing: Measuring preferences for the allocation of the health budget," Social Science & Medicine, Elsevier, vol. 75(8), pages 1351-1361.
    15. Lancsar, Emily & Wildman, John & Donaldson, Cam & Ryan, Mandy & Baker, Rachel, 2011. "Deriving distributional weights for QALYs through discrete choice experiments," Journal of Health Economics, Elsevier, vol. 30(2), pages 466-478, March.
    16. Dana Goldman & Darius Lakdawalla & Tomas J. Philipson & Wesley Yin, 2010. "Valuing health technologies at nice: recommendations for improved incorporation of treatment value in HTA," Health Economics, John Wiley & Sons, Ltd., vol. 19(10), pages 1109-1116, October.
    17. Anthony J. Culyer & Yvonne Bombard, 2012. "An Equity Framework for Health Technology Assessments," Medical Decision Making, , vol. 32(3), pages 428-441, May.
    18. Eyal Gamliel & Eyal Peer, 2010. "Attribute framing affects the perceived fairness of health care allocation principles," Judgment and Decision Making, Society for Judgment and Decision Making, vol. 5(1), pages 11-20, February.
    19. Anthony J Culyer & Yvonne Bombard, 2011. "An Equity Checklist: a Framework for Health Technology Assessments," Working Papers 062cherp, Centre for Health Economics, University of York.
    20. Benjamin Ouvrard & Arnaud Reynaud & Stéphane Cezera & Alban Thomas & Dishant Jojit James & Murudaiah Shivamurthy, 2023. "Distributive Justice in the Field: How do Indian Farmers Share Water? ," Working Papers hal-04150233, HAL.

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