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Morality and the limits of societal values in health care allocation

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  • Rebecca L. Walker
  • Andrew W. Siegel

Abstract

In this paper, we consider whether there is a clear moral justification for the proposal that societal value preferences (SVPs) should be included in Cost Effectiveness Analyses (CEA) of health care resource allocations. We argue, first, that proponents of the use of SVPs need to be clear about the relationship between these values and moral principles. In particular, once moral principles are accepted as ruling out some SVPs (such as those that are irrational or revealing prejudice), an account is required of why we need to appeal to SVPs rather than moral principles to determine a just division of health care resources. Secondly, we consider whether an independent moral justification might underwrite the use of SVPs. In various places in the literature the notions of representation, presumed consent and democratic decision making appear to be invoked as candidates for fulfilling this justificatory role. We discuss some problems with each of these justifications in the hope of eliciting a more comprehensive proposal from the proponents of SVPs. We conclude that, although a number of interesting proposals have been made, no compelling justification for including SVPs in CEA has yet been systematically articulated. Copyright © 2002 John Wiley & Sons, Ltd.

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  • Rebecca L. Walker & Andrew W. Siegel, 2002. "Morality and the limits of societal values in health care allocation," Health Economics, John Wiley & Sons, Ltd., vol. 11(3), pages 265-273, April.
    • Handle: RePEc:wly:hlthec:v:11:y:2002:i:3:p:265-273
    DOI: 10.1002/hec.665
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    References listed on IDEAS

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    1. Erik Nord & Jose Luis Pinto & Jeff Richardson & Paul Menzel & Peter Ubel, 1999. "Incorporating societal concerns for fairness in numerical valuations of health programmes," Health Economics, John Wiley & Sons, Ltd., vol. 8(1), pages 25-39, February.
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    1. Abellán Perpiñán, José Mª & Sánchez Martínez,Fernando I. & Martínez Pérez, Jorge E., 2007. "La medición del bienestar social relacionado con la salud/The Measurement of the Health Related Social Welfare," Estudios de Economia Aplicada, Estudios de Economia Aplicada, vol. 25, pages 927-950, Diciembre.
    2. Erik Nord & Jose Luis Pinto & Jeff Richardson & Paul Menzel & Peter Ubel, 1999. "Incorporating societal concerns for fairness in numerical valuations of health programmes," Health Economics, John Wiley & Sons, Ltd., vol. 8(1), pages 25-39, February.
    3. Afschin Gandjour, 2017. "Comment on: “Can the EVIDEM Framework Tackle Issues Raised by Evaluating Treatments for Rare Diseases: Analysis of Issues and Policies, and Context-Specific Adaptation”," PharmacoEconomics, Springer, vol. 35(5), pages 603-604, May.

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