Which of two individuals do you treat when only their ages are different and you can't treat both?

Lewis, Peter; Charny, Mark

doi:10.1136/jme.15.1.28

Cited by 84 publications

(69 citation statements)

References 3 publications

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“…Johannesson and Johannsson report undiscounted weights for life years gained at ages 30, 50 and 70 of 1.0; 0.22; and 0.1, respectively [40]. Lewis and Charny show that respondents have a very strong preference for 5 year olds over 70 year olds, a strong preference for 35 year olds over 60 year olds and a slight preference for 8 year olds over 2 year olds [41].…”

Section: Qaly Maximisationmentioning

confidence: 99%

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QALY maximisation and people's preferences: a methodological review of the literature

et al. 2004

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SummaryIn cost-utility analysis, the numbers of quality-adjusted life years (QALYs) gained are aggregated according to the sum-ranking (or QALY maximisation) rule. This requires that the social value from health improvements is a simple product of gains in quality of life, length of life and the number of persons treated. The results from a systematic review of the literature suggest that QALY maximisation is descriptively flawed. Rather than being linear in quality and length of life, it would seem that social value diminishes in marginal increments of both. And rather than being neutral to the characteristics of people other than their propensity to generate QALYs, the social value of a health improvement seems to be higher if the person has worse lifetime health prospects and higher if that person has dependents. In addition, there is a desire to reduce inequalities in health. However, there are some uncertainties surrounding the results, particularly in relation to what might be affecting the responses, and there is the need for more studies of the general public that attempt to highlight the relative importance of various key factors. Copyright

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Section: Qaly Maximisationmentioning

confidence: 99%

“…There is empirical evidence that some people (but by no means a clear majority) wish to give less priority to those who are considered to be in some way responsible for their ill health [30,36,41,42,48]. In the Gallup Poll in August 1994, 41% of respondents wanted lower priority for those with self-inflicted illnesses.…”

Section: Qaly Maximisationmentioning

confidence: 99%

QALY maximisation and people's preferences: a methodological review of the literature

et al. 2004

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“…Studies based on choice scenarios in life-saving contexts show a marked preference favouring children and young adults over elderly people. Lewis and Charney found that 80% of people interviewed in the UK thought that 35 year olds should have priority over 60 year olds in receiving life-saving treatment [10]. Tamura et al found that a majority of Japanese thought younger patients should receive priority over older ones for emergency operations.…”

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confidence: 98%

The importance of age in allocating health care resources: does intervention-type matter?

et al. 2005

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“…Discounting, widely used in an attempt to reflect time preferences, works under the presumption of a linear social time preference; that is, that the value of health diminishes at a constant rate over time. It is unclear how much this applies to health states, but the little empirical evidence available suggests that time, rather than having a linear effect on the desirability of good health, seems to have an uneven effect, increasing and decreasing through life stages (Lewis and Charny 1989;Wright 1986). Benefit-cost analyses, which assign dollar values to health benefits ($2 million per life saved, for example), are likely to fail when we consider the issue of discounting benefits.…”

Section: Cost-utility Analysismentioning

confidence: 96%

Allocating Health Care: Cost-Utility Analysis, Informed Democratic Decision Making, or the Veil of Ignorance?

Goold

1996

Journal of Health Politics, Policy and Law

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Assuming that rationing health care is unavoidable, and that it requires moral reasoning, how should we allocate limited health care resources? This question is difficult because our pluralistic, liberal society has no consensus on a conception of distributive justice. In this article I focus on an alternative: Who shall decide how to ration health care, and how shall this be done to respect autonomy, pluralism, liberalism, and fairness? I explore three processes for making rationing decisions: cost-utility analysis, informed democratic decision making, and applications of the veil of ignorance. I evaluate these processes as examples of procedural justice, assuming that there is no outcome considered the most just. I use consent as a criterion to judge competing processes so that rationing decisions are, to some extent, self-imposed. I also examine the processes' feasibility in our current health care system. Cost-utility analysis does not meet criteria for actual or presumed consent, even if costs and health-related utility could be measured perfectly. Existing structures of government cannot creditably assimilate the information required for sound rationing decisions, and grassroots efforts are not representative. Applications of the veil of ignorance are more useful for identifying principles relevant to health care rationing than for making concrete rationing decisions. I outline a process of decision making, specifically for health care, that relies on substantive, selected representation, respects pluralism, liberalism, and deliberative democracy, and could be implemented at the community or organizational level.

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Which of two individuals do you treat when only their ages are different and you can't treat both?

Cited by 84 publications

References 3 publications

QALY maximisation and people's preferences: a methodological review of the literature

QALY maximisation and people's preferences: a methodological review of the literature

The importance of age in allocating health care resources: does intervention-type matter?

Allocating Health Care: Cost-Utility Analysis, Informed Democratic Decision Making, or the Veil of Ignorance?

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