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Cost-Effectiveness and the Avoidance of Discrimination in Healthcare: Can We Have Both?

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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.

Original languageEnglish
JournalCambridge Quarterly of Healthcare Ethics
Pages (from-to)202-215
Number of pages14
Publication statusPublished - Apr 2023

    Research areas

  • ableism, ageism, compounding injustice, discrimination, distributive justice in healthcare, healthcare rationing, moral worth, QALY

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