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COST-EFFECTIVENESS AND DISABILITY DISCRIMINATION

Published online by Cambridge University Press:  01 March 2009

Dan W. Brock
Dan W. Brock*
Affiliation:
Harvard University
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Abstract

It is widely recognized that prioritizing health care resources by their relative cost-effectiveness can result in lower priority for the treatment of disabled persons than otherwise similar non-disabled persons. I distinguish six different ways in which this discrimination against the disabled can occur. I then spell out and evaluate the following moral objections to this discrimination, most of which capture an aspect of its unethical character: it implies that disabled persons' lives are of lesser value than those of non-disabled persons; it constitutes “double jeopardy” or violates Frances Kamm's non-linkage principle; it conflicts with equality of opportunity; it conflicts with fairness, which requires ignoring (some/most) differential impacts of treatment; it wrongly gives lower priority to disabled persons for equally effective treatment; it conflicts with giving all persons an equal chance to reach their full potential; and, it is in conflict with giving priority to the worse off.

Type
Essay
Information
Economics & Philosophy , Volume 25 , Issue 1 , March 2009 , pp. 27 - 47
Copyright
Copyright © Cambridge University Press 2009

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References

REFERENCES

Arneson, R. 2007. Desert and equality. In Egalitarianism: New essays on the nature and value of equality, Holtug, N. and Lippert-Rasmussen, K., ed. Oxford: Oxford University Press.Google Scholar
Brock, D.W. 1995. Justice and the ADA: does prioritizing and rationing health care discriminate against the disabled? Social Philosophy and Policy 159–85.CrossRefGoogle Scholar
Brock, D.W. 2000. Health care prioritization and discrimination against persons with disabilities. In Americans with Disabilities: implications for individuals and institutions, Francis, L. & Silvers, A., ed. New York: Routledge.Google Scholar
Brock, D.W. 2003. Separate spheres and indirect benefits. Cost-Effectiveness and Resource Allocation 1: 4.CrossRefGoogle ScholarPubMed
Broome, J. 1991. Weighing goods. Oxford: Blackwell.Google Scholar
Broome, J. 1999. Fairness. In Ethics out of economics, Ch. 7. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Buchanan, A., Brock, D. W., Daniels, N. and Wikler, D.. 2000. From chance to choice: Genetics and justice. New York: Cambridge University Press.CrossRefGoogle Scholar
Cohen, G. A. 1989. On the currency of egalitarian justice. Ethics 99: 906–44.CrossRefGoogle Scholar
Daniels, N. 1985. Just health care. Cambridge: Cambridge University Press.CrossRefGoogle ScholarPubMed
Daniels, N. 2008. Just health: Meeting health needs fairly. Cambridge: Cambridge University Press.Google Scholar
Dworkin, R. 1981. What is equality? Parts I and II. Philosophy and Public Affairs 10: 185–246 and 10: 283–345.Google Scholar
Fleurbaey, M. 1995. Equality and responsibility. European Economic Review 39: 683–9.CrossRefGoogle Scholar
Gold, M., Siegel, J., Russell, L. and Weinstein, M., ed. 1996. Cost-effectiveness in health and medicine. New York: Oxford University Press.CrossRefGoogle ScholarPubMed
Hadorn, D. 1992. The problem of discrimination in health care priority setting. Journal of the American Medical Association 268: 1454–9.CrossRefGoogle ScholarPubMed
Harris, J. 1987. Qualifying the value of life. Journal of Medical Ethics 13: 117–23.CrossRefGoogle Scholar
Harris, J. 1988. Quality, value and justice. Health Policy 10: 259–66.CrossRefGoogle ScholarPubMed
Harris, J. 1995. Double Jeopardy and the Veil of Ignorance – a reply. Journal of Medical Ethics 21: 151–7.CrossRefGoogle ScholarPubMed
Hurley, S. L. 2003. Justice, luck, and knowledge. Cambridge, MA: Harvard University Press.Google Scholar
Kamm, F. 2004. Deciding whom to help, health-adjusted life years, and disabilities. In Health and equity, Annand, P. and Sen, A., ed. Oxford: Oxford University Press.Google Scholar
McKie, J., Richardson, J., Singer, P. and Kuhse, H.. 1998. The allocation of medical resources: An ethical evaluation of the ‘QALY’ Approach, Ch. 5. Aldershot, UK: Dartmouth Publishing.Google Scholar
Menzel, P. T. 1992. Oregon's denial: Disabilities andquality of life. Hastings Center Report 22: 21–5.CrossRefGoogle Scholar
Nord, E. 1999. Cost-value analysis in health care. Cambridge: Cambridge University Press.CrossRefGoogle ScholarPubMed
Nord, E. et al. 1999. Incorporating societal concerns for fairness in numerical evaluations of health programmes. Health Economics 8: 25–39.3.0.CO;2-H>CrossRefGoogle ScholarPubMed
Orentlicher, D. 1994. Rationing and the Americans with Disabilities Act. Journal of the American Medical Association 271: 308–14.CrossRefGoogle ScholarPubMed
Parens, E. and Asch, A.. 2000. The disability rights critique of prenatal genetic testing: reflections and recommendations. In Prenatal testing and disability rights, Parens, E. and Asch, A., ed. Washington, DC: Georgetown University Press.Google Scholar
Parfit, D. 1991. Equality or priority. The Lindley Lecture. Copyright: Department of Philosophy, University of Kansas.Google Scholar
Roemer, J. 1998. Equality of opportunity. Cambridge, MA: Harvard University Press.CrossRefGoogle Scholar