TY - JOUR
T1 - Cost-Effectiveness and the Avoidance of Discrimination in Healthcare
T2 - Can We Have Both?
AU - Lippert-Rasmussen, Kasper
PY - 2023/4
Y1 - 2023/4
N2 - Many ethical theorists believe that a given distribution of healthcare is morally justified only if (1) it is cost-effective and (2) it does not discriminate against older adults and disabled people. However, if (3) cost-effectiveness involves maximizing the number of quality-adjusted life-years (QALYs) added by a given unit of healthcare resource, or cost, it seems the pursuit of cost-effectiveness will inevitably discriminate against older adults and disabled patients. I show why this trilemma is harder to escape than some theorists think. We cannot avoid it by using age- or disability-weighted QALY scores, for example. I then explain why there is no sense of discrimination on which discrimination is both unjust, and thus something healthcare rationing must avoid, and something cost-effective healthcare rationing inevitably involves. I go on to argue that many of the reasons we have for not favoring rationing that maximizes QALYs outside the healthcare context apply in healthcare as well. Thus, claim (1) above is dubious.
AB - Many ethical theorists believe that a given distribution of healthcare is morally justified only if (1) it is cost-effective and (2) it does not discriminate against older adults and disabled people. However, if (3) cost-effectiveness involves maximizing the number of quality-adjusted life-years (QALYs) added by a given unit of healthcare resource, or cost, it seems the pursuit of cost-effectiveness will inevitably discriminate against older adults and disabled patients. I show why this trilemma is harder to escape than some theorists think. We cannot avoid it by using age- or disability-weighted QALY scores, for example. I then explain why there is no sense of discrimination on which discrimination is both unjust, and thus something healthcare rationing must avoid, and something cost-effective healthcare rationing inevitably involves. I go on to argue that many of the reasons we have for not favoring rationing that maximizes QALYs outside the healthcare context apply in healthcare as well. Thus, claim (1) above is dubious.
KW - ableism
KW - ageism
KW - compounding injustice
KW - discrimination
KW - distributive justice in healthcare
KW - healthcare rationing
KW - moral worth
KW - QALY
UR - http://www.scopus.com/inward/record.url?scp=85143788018&partnerID=8YFLogxK
U2 - 10.1017/S096318012200024X
DO - 10.1017/S096318012200024X
M3 - Journal article
C2 - 36330817
AN - SCOPUS:85143788018
SN - 0963-1801
VL - 32
SP - 202
EP - 215
JO - Cambridge Quarterly of Healthcare Ethics
JF - Cambridge Quarterly of Healthcare Ethics
IS - 2
ER -