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.
Chapter 1. Introduction Part One. Theory Chapter 2. Utilitarianism Chapter 3. The maximin/leximin theory Chapter 4. Egalitarianism Chapter 5. Prioritarianism Chapter 6. Some controversial implications of the three theories Chapter 7. Population ethics Chapter 8. Utilitarianism with or without a prioritarian amendment? Part Two. Practice Chapter 9. Ideal and nonideal theory Chapter 10. Triage in situations of mass casualty Chapter 11. The maximin/leximin theory: in real life Chapter 12. Utilitarianism/prioritarianism: in real life Chapter 13. Conclusion
Torbjoern Tannsjoe has published extensively in moral philosophy, political philosophy, and bioethics. His most recent books are Understanding Ethics (Edinburgh UP), a simple introduction to normative ethics, and Taking Life: Three Theories on the Ethics of Killing (OUP, 2015).
Reviews for Setting Health-Care Priorities: What Ethical Theories Tell Us
In Setting Health-Care Priorities, Torbjorn Tannsjoe examines how the leading ethical theories answer the important practical question suggested in the title of his book. He reaches a startling conclusion: whether we are utilitarians, egalitarians, prioritarians or Rawlsians, we should agree that the way in which health care resources are allocated in all developed countries is wrong. We should spend less on the elderly, and on those suffering from rare diseases, and more on improving mental health. This book is a model of clear philosophical argument leading to an important practical conclusion. It is suitable for students and general readers, but I hope it will also be widely read by those in a position to influence health care policy. -- Peter Singer, Princeton University A perfect example of how clear thinking and a clear objective lead to radically new priorities. -- Richard Layard, London School of Economics