Setting Health-Care Priorities (PDF)

by Torbjörn Tännsjö

With much of the world’s population facing restricted access to adequate medical care, how to allocate scarce health-care resources is a pressing question for governments, hospitals, and individuals. How do we decide where funding for health-care programs should go? Tannsjo here approaches the subject from a philosophical perspective, balancing theoretical treatments of distributive ethics with real-world examples of how health-care is administered around the world today.
Tannsjo begins by laying out several popular ethical theories-utilitarianism, which recommends maximizing the best overall outcome; egalitarianism, which recommends smoothing out the differences between people as much as possible; and the maximin/leximin theory, which urges people to give absolute priority to those who are worst off. Tannsjo shows how, in abstract thought experiments, these theories come into conflict with each other and reveal puzzling implications. He goes on to argue, however, that when we consider health-care in the real-world, these theories all agree on a central point: in a well-ordered welfare state, more resources should be directed to the care and cure of people suffering from mental illness, and less to the marginal life extension of elderly patients. Tannsjo’s book thus recommends a shift in spending to increase fairness and overall utility-while also recognizing that this kind of dispassionate suggestion, with its purely economic foundation, is unlikely to take hold in policy. Tannsjo’s analysis is a case study in how ethical theories can sometimes lead to rational conclusions and recommendations that we are not prepared to accept.