Abstract
Principles of need are constantly referred to in health care priority setting. The common denominator for any principle of need is that it will ascribe some kind of special normative weight to people being worse off. However, this common ground does not answer the question how a plausible principle of need should relate to the aggregation of benefits across individuals. Principles of need are sometimes stated as being incompatible with aggregation and sometimes characterized as accepting aggregation in much the same way as utilitarians do. In this paper we argue that if one wants to take principles of need seriously both of these positions have unreasonable implications. We then characterize and defend a principle of need consisting of sufficientarian elements as well as prioritarian which avoids these unreasonable implications.
Highlights
Principles of need are commonly discussed and employed in health care priority setting [7, 15, 16, 21, 22, 26, 28, 35, 37, 40]
In other words: even though the priority view does account for the diminishing moral importance of benefits there still seems to be some cut off point for when benefits have no, or significantly less, moral importance [see 5]. Does this objection have any relevance for constructing a principle of need for health care priority setting? While Double Threshold Priority (DTP) prohibits tradeoffs between the best off and the worst off, it still employs the priority view within the groups
We have examined how a principle of need, applied in health care priority setting, should relate to the aggregation thesis
Summary
Principles of need are commonly discussed and employed in health care priority setting [7, 15, 16, 21, 22, 26, 28, 35, 37, 40]. The priority to group (A) is implied by the principle of cost-effectiveness since it employs unrestricted aggregation, regardless of, for instance, how badly off those are to whom the benefits accrue We employ this case in order to explicate the moral intuition that there is something wrong when benefits to people who are among the worst off are outweighed by benefits to people who are among the best off.. For simplicity reasons we shall assume that DTP is a principle for distributing treatments rather than diagnostic measures among patients.12 This does not, commit us to the view, held by some people [e.g. 22], that the problem of priority setting is primarily a problem about what health care interventions that should be funded. In DTP, the purpose of the thresholds is not to give absolute priority to people below the lower threshold (as in Crisp’s view) but to adjust the way in which benefits may be aggregated between different levels of health. As one increases the number of thresholds one decreases the extent to which DTP plausibly accounts for the moral importance of this difference
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