Macro-allocation: How should a society divide up its resources to fund health care?
Micro-allocation: Within a health care system, what services should be provided?
Note: these two questions can be interconnected, because increasing services in micro-allocation may require increasing resources in macro-allocation.
Purposive vs. functional approaches (from ch. 3).
From Thagard, The Brain and the Meaning of Life, 2010.
Need: Condition without which a person would be harmed.
Vital need: Something without which a person cannot function as a human being .
Competence: Psychological need to engage optimal challenges and experience physical and social mastery.
Autonomy: Psychological need to self-organize and regulate one’s own behavior and avoid control by others.
Relatedness: Psychological need for social attachments and feelings of security, belongingness, and intimacy with others.
Self-determination theory argues for these psychological needs.
What should be the basis for rationing health care?
Option 1: Treat old people the same as anyone else.
Option 2: Restrict expensive medical treatments for old people.
Arguments for Option 2:
Arguments for Option 1:
Consequences: non-alcoholics will have better outcomes.
Rights: but don't alcoholics have the same rights to health care?
Principles: does equality require equal treatment of alcoholics?
1. Choose interventions known to be beneficial on the basis of evidence of effectiveness.
Current issue: should patients with multiple sclerosis be provided with liberation therapy?
2. Minimize marginally beneficial tests or interventions.
3. Seek low cost treatments and interventions.
4. Advocate for one's patients but don't manipulate the system.
5. Resolve claims for scarce resources fairly on the basis of need and benefit.
6. Sensitively inform patients of cost constraints.
7. Seek resolution of shortages.
Examples where medical intervention may be futile:
Arguments against decisions based on futility:
Do you know any people who have been denied access to health care they wanted? Was the denial justified?
United Nations declaration of human rights
Canadian Charter of Rights and Freedoms
1. Skeptical: There are no human rights.
Pure consequentialism: Ethics is only concerned with consequences.
2. Minimal (Libertarian): The only human right is to not be harmed by others.
3. Basic (Brian Orend, Human Rights, 2002):
There are five foundational human rights: personal security, material subsistence, personal freedom, elemental equality, and social recognition.
These are justified because they are required for the satisfaction of vital human needs, without which a person cannot function as a human being.
4. Maximal: There are many human rights listed in the declarations above.
Computational Epistemology Laboratory.
This page updated Sept. 24, 2012