Resource Allocation in Health Care and the Role of Personal Autonomy

Abstract

Resource allocation decisions in health care require the consideration of ethical values. Major ethical theories include Amartya Sen’s capability approach, Norman Daniels’s theory of justice for health, and preference utilitarian theory. This paper argues that while only preference utilitarian theory explicitly considers the impact of an individual’s actions on others, all 3 theories agree in terms of providing individual autonomy. Furthermore, it shows that all 3 theories emphasise the role of informed preferences in securing individual autonomy. Still, stressing personal autonomy has limited direct implications for priority setting. 2 priority rules for resource allocation could be identified: 1) to give priority to patients with mental disability (over those with pure physical disability); and 2) to give priority to patients with a large expected loss of autonomy without treatment.

Zusammenfassung

Allokationsentscheidungen im Gesundheitswesen erfordern die Berücksichtigung ethischer Werte. Zu wichtigen ethischen Theorien gehören der Capability Approach (Sen), die Theorie einer gerechten Gesundheitsversorgung (Daniels) und der Präferenzutilitarismus. Diese Arbeit argumentiert, dass alle 3 Theorien hinsichtlich der Notwendigkeit, individuelle Autonomie sicherzustellen, übereinstimmen. Sie zeigt, dass die Betonung individueller Autonomie mentalen Erkrankungen Priorität einräumt.

Key words

health care - social justice - personal autonomy

Schlüsselwörter

Gesundheitswesen - soziale Gerechtigkeit - individuelle Autonomie

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