Substantive principles of justice in health care rationing
| Class of principle | Variants that have been proposed in the literature | Recommendation in our exercise* |
|---|---|---|
| *This is based on various working assumptions described in the main text of this paper, in particular (1) that Steve and Marinder have an equal degree of immediate ill-health, (2) that Steve will gain the most health from treatment (over his entire lifetime), that Joanne will gain the least, and that Daniel and Marinder will gain the same amount, (3) that treating Marinder would have a substantial indirect health benefit for others by freeing up long term care resources; and (4) that Joanne had more choice about her health predicament than Steve. | ||
| A. Need principles | Distribute in proportion to degree of immediate threat to life | Daniel, Joanne |
| Distribute in proportion to degree of immediate ill-health | Daniel, Marinder & Steve equal, Joanne | |
| Distribute in proportion to degree of lifetime ill-health | Daniel, Joanne, Steve, Marinder | |
| Distribute in proportion to immediate capacity to benefit | Daniel, Marinder & Steve equal, Joanne | |
| Distribute in proportion to lifetime capacity to benefit | Steve, Daniel & Marinder equal, Joanne | |
| Distribute in proportion to cost of exhausting capacity to benefit | Equal chance for all four patients | |
| B. Maximising principles | Maximise health | Steve, Marinder, Daniel, Joanne |
| Maximise wellbeing (including non-health aspects) | ? Depends on non-health factors | |
| C. Egalitarian principles | Equalise lifetime health expectancy (“fair innings” argument) | Daniel, Joanne, Steve, Marinder |
| Equalise opportunity for lifetime health expectancy | Daniel, Steve, Joanne, Marinder | |
| D. Combination principles | Combine maximise health with equalise lifetime health expectancy | Steve, Daniel, Marinder, Joanne |
| Combine a need principle with a maximising principle | ? Depends on which versions of the principles and what weights | |