Social Choice, Health and Fairness
The main conceptual framework of classical social choice places preference conflicts between agents centre-stage. This paper develops the case for a second conception of social choice where entitlements are established through the integration of different, primitive classes of claim and supports the thesis with an examination of its application to health-care rationing. It begins by arguing that the axiomatic characterisation of dictatorship and its association with unfairness are both flawed. The paper then proposes that fair social choices integrate different types of claims and shows how non-linear programming can provide an optimisation framework for doing this. Four claims types are identified as particularly significant: consequences, de-ontological claims such as rights, contracts including social contracts and political mandates, and beliefs about procedural fairness. It is then shown how the existence of these claims helps make sense of objections to QALY maximisation, a hitherto predominant social welfare function in health economics. Throughout the paper, the emphasis is on the nature of theory required to structure empirical social choice whilst capturing, formally, ethical objections to a widely used social choice procedure.
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|Date of creation:||Sep 2002|
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