Prioritarianism in Health-Care: Resisting the Reduction to Utilitarianism
Article Sidebar
Main Article Content
Abstract
Tännsjö’s book Setting Health-Care Priorities defends the view that there are three main normative theories in the domain of distributive justice, and that these theories are both highly plausible in themselves, and practically convergent in their normative conclusions. All three theories (utilitarianism, the maximin/leximin theory and egalitarianism) point to a somewhat radical departure from the present distribution of medical resources: in particular, they suggest redirecting resources from marginal life extension to the care of mentally ill patients. In this paper I wish to argue, firstly, that prioritarianism should not be considered as an amendment to utilitarianism, as it is in Tännsjö’s view, but as a distinctive fourth option. This can best be appreciated if we focus on a reading of the theory that emphasizes its derivation from egalitarianism and its attempt to develop an intermediate approach between utilitarian and egalitarian intuitions. Secondly, in response to Tännsjö’s central objection to prioritarianism, I will argue that the theory does not apply in intrapersonal cases but is only relevant for decisions regarding the interpersonal distribution of benefits. Finally, I will suggest that a practical convergence of the four theories on specific issues such as artificial reproduction or mood enhancement is far less likely than Tännsjö seems to believe.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
By submitting his/her work to the Editorial Board, the author accepts, upon having his/her text recommended for publication, that Diametros applies the Attribution 4.0 International (CC BY 4.0) license to the works we publish. Under this license, authors agree to make articles legally available for reuse, without permission or fees. Anyone may read, download, copy, print, distribute or reuse these articles without asking prior permission from the publisher or the author, as long as the author and original source are properly cited. The author holds the copyright without any other restrictions. Full information about CC-BY: https://creativecommons.org/licenses/by/4.0/legalcode.
References
Arneson R.J. (2000), “Luck Egalitarianism and Prioritarianism,” Ethics 110 (2): 339–349.
DOI: https://doi.org/10.1086/233272
Brock D.W. (2009), “Cost-Effectiveness and Disability Discrimination,” Economics and Philosophy 25 (1): 27–47.
DOI: https://doi.org/10.1017/S0266267108002265
Broome J. (2004), Weighing Lives, Oxford University Press, Oxford.
DOI: https://doi.org/10.1093/019924376X.001.0001
Buchanan A., Brock D.W., Daniels N. and Wikler D. (2000), From Chance to Choice: Genetics and Justice, Cambridge University Press, New York.
DOI: https://doi.org/10.1017/CBO9780511806940
Daniels N. (1985), Just Health Care, Cambridge University Press, New York.
DOI: https://doi.org/10.1017/CBO9780511624971
Daniels N. (2008), Just Health. Meeting Health Needs Fairly, Cambridge University Press, Cambridge.
DOI: https://doi.org/10.1017/CBO9780511809514
Fleurbaey, M. (2015), “Equality versus Priority: How Relevant Is the Distinction?,” Economics and Philosophy 31 (2): 203–217.
DOI: https://doi.org/10.1017/S0266267115000085
Fleurbaey M., Tungodden B., Vallentyne P. (2009), “On the possibility of nonaggregative priority for the worst off,” Social Philosophy and Policy 26 (1): 258–285.
DOI: https://doi.org/10.1017/S0265052509090116
Harris J. (1987), “QALYfying the Value of Life,” Journal of Medical Ethics 13 (3): 117–123.
DOI: https://doi.org/10.1136/jme.13.3.117
Holtug N. (2007), “Prioritarianism,” [in:] Egalitarianism: New Essays on the Nature and Value of Equality, N. Holtug, K. Lippert-Rasmussen (eds), Clarendon Press, Oxford: 125–156.
Jensen K.K. (2003), “What is the difference between (moderate) egalitarianism and prioritarianism?,” Economics & Philosophy 19 (1): 89–109.
DOI: https://doi.org/10.1017/S0266267103001032
Nagel T. (1978), “The Justification of Equality,” Crítica: Revista Hispanoamericana de Filosofía 10 (28): 3–31.
DOI: https://doi.org/10.22201/iifs.18704905e.1978.260
Nagel T. (1991), Equality and Partiality, Oxford University Press, New York.
O’Neill M. (2012), “Priority, Preference, and Value,” Utilitas 24 (3): 332–348.
DOI: https://doi.org/10.1017/S0953820812000118
Otsuka M., Voorhoeve A. (2009), “Why It Matters That Some Are Worse Off Than Others: An Argument Against the Priority View,” Philosophy and Public Affairs 37 (2): 171–199.
DOI: https://doi.org/10.1111/j.1088-4963.2009.01154.x
Parfit D. (1997), “Equality and Partiality,” Ratio 10 (3): 202–221.
DOI: https://doi.org/10.1111/1467-9329.00041
Parfit D. (2011), On What Matters, vol. 1, Oxford University Press, Oxford.
DOI: https://doi.org/10.1093/acprof:osobl/9780199572809.001.0001
Parfit D. (2012), “Another Defence of the Priority View,” Utilitas 24 (3): 399–440.
DOI: https://doi.org/10.1017/S095382081200009X
Persson I. (2008) “Why levelling down could be worse for prioritarianism than for egalitarianism,” Ethical Theory and Moral Practice 11 (3): 295–303.
DOI: https://doi.org/10.1007/s10677-007-9102-6
Porter T. (2011), “Prioritarianism and the Levelling Down Objection,” Ethical Theory and Moral Practice 14 (2): 197–206.
DOI: https://doi.org/10.1007/s10677-010-9231-1
Rabinowicz W. (2002), “Prioritarianism and Uncertainty: On the Interpersonal Addition Theorem and the Priority View,” [in:] Exploring Practical Philosophy: From Action to Values, D. Egonsson, J. Josefsson, B. Petersson, T. Ronnow-Rasmussen, I. Persson (eds), Ashgate, Aldershot (UK): 139–165.
Segall S. (2016), Why Inequality Matters: Luck Egalitarianism, Its Meaning and Value, Cambridge University Press, Cambridge.
DOI: https://doi.org/10.1017/CBO9781316416969
Sidgwick H. (1981), The Methods of Ethics, Hackett Publishing Company, Indianapolis/Cambridge.
Tännsjö T. (2019), Setting Health-Care Priorities: What Ethical Theories Tell Us, Oxford University Press, New York.
DOI: https://doi.org/10.1093/oso/9780190946883.001.0001