Against proportional shortfall as a priority-setting principle.

Abstract:

:As the demand for healthcare rises, so does the need for priority setting in healthcare. In this paper, I consider a prominent priority-setting principle: proportional shortfall. My purpose is to argue that proportional shortfall, as a principle, should not be adopted. My key criticism is that proportional shortfall fails to consider past health.Proportional shortfall is justified as it supposedly balances concern for prospective health while still accounting for lifetime health, even though past health is deemed irrelevant. Accounting for this lifetime perspective means that the principle may indirectly consider past health by accounting for how far an individual is from achieving a complete, healthy life. I argue that proportional shortfall does not account for this lifetime perspective as it fails to incorporate the fair innings argument as originally claimed, undermining its purported justification.I go on to demonstrate that the case for ignoring past health is weak, and argue that past health is at least sometimes relevant for priority-setting decisions. Specifically, when an individual's past health has a direct impact on current or future health, and when one individual has enjoyed significantly more healthy life years than another.Finally, I demonstrate that by ignoring past illnesses, even those entirely unrelated to their current illness, proportional shortfall can lead to instances of double jeopardy, a highly problematic implication. These arguments give us reason to reject proportional shortfall.

journal_name

J Med Ethics

authors

Altmann S

doi

10.1136/medethics-2017-104488

subject

Has Abstract

pub_date

2018-05-01 00:00:00

pages

305-309

issue

5

eissn

0306-6800

issn

1473-4257

pii

medethics-2017-104488

journal_volume

44

pub_type

杂志文章
  • The annual reports of Local Research Ethics Committees.

    abstract::Each Local Research Ethics Committee (LREC) is expected to produce an annual report for its establishing authority. Reports from 145 LRECs were examined with regard to (a) whether the committees were working within the terms of the most recent guidelines from the Department of Health and (b) observations on the role o...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.21.4.214

    authors: Foster CG,Marshall T,Moodie P

    更新日期:1995-08-01 00:00:00

  • Legitimacy in bioethics: challenging the orthodoxy.

    abstract::Several prominent writers including Norman Daniels, James Sabin, Amy Gutmann, Dennis Thompson and Leonard Fleck advance a view of legitimacy according to which, roughly, policies are legitimate if and only if they result from democratic deliberation, which employs only public reasons that are publicised to stakeholder...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2017-104559

    authors: Smith WR

    更新日期:2018-06-01 00:00:00

  • Caring for risky patients: duty or virtue?

    abstract::The emergence several years ago of SARS, with its high rate of infection and death among healthcare workers, resurrected a recurring ethical question: do health professionals have a duty to provide care to patients with deadly infectious diseases, even at some substantial risk to themselves and their families? The con...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2007.022038

    authors: Tomlinson T

    更新日期:2008-06-01 00:00:00

  • The Nordic concept of 'faellesskab'.

    abstract::The complex of cultural, political and societal affiliations, both in a historic and a contemporary perspective, is expressed by a special term in the Nordic languages, 'faellesskab', often with the addition of 'folkelig', as 'folkeligt faellesskab', where 'folkelig' means of the people. No corresponding term exists i...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.17.1.41

    authors: Riis P

    更新日期:1991-03-01 00:00:00

  • 'Serious' science: a response to Kleiderman, Ravitsky and Knoppers.

    abstract::In their paper 'The "serious" factor in germline modification', Kleiderman, Ravitsky and Knoppers rightly highlight the ambiguity in the oft-utilised term 'serious' in legal discussions of human germline genome modification.1 They suggest interpretation of this term may benefit from a framework based on human rights r...

    journal_title:Journal of medical ethics

    pub_type: 评论,杂志文章

    doi:10.1136/medethics-2019-105764

    authors: Kalsi S

    更新日期:2020-02-01 00:00:00

  • Health and disease: what can medicine do for philosophy?

    abstract::Philosophical discussions about health and disease often refer to a 'medical model' of bodily disease, in which diseases are regarded as causes of illness; diagnosis consists in identifying the disease affecting the patient, and this determines the appropriate treatment. This view is plausible only for diseases whose ...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.14.3.118

    authors: Scadding JG

    更新日期:1988-09-01 00:00:00

  • Spontaneous abortion and unexpected death: a critical discussion of Marquis on abortion.

    abstract::In his classic paper, 'Why abortion is immoral', Don Marquis argues that what makes killing an adult seriously immoral is that it deprives the victim of the valuable future he/she would have otherwise had. Moreover, Marquis contends, because abortion deprives a fetus of the very same thing, aborting a fetus is just as...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2012-100604

    authors: Coleman MC

    更新日期:2013-02-01 00:00:00

  • Assessing research risks systematically: the net risks test.

    abstract::Dual-track assessment directs research ethics committees (RECs) to assess the risks of research interventions based on the unclear distinction between therapeutic and non-therapeutic interventions. The net risks test, in contrast, relies on the clinically familiar method of assessing the risks and benefits of interven...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2005.014043

    authors: Wendler D,Miller FG

    更新日期:2007-08-01 00:00:00

  • How medical ethical principles are applied in treatment with artificial insemination by donors (AID) in Hunan, China: effective practice at the Reproductive and Genetic Hospital of CITIC-Xiangya.

    abstract::This paper investigates the efficiency of application of medical ethics principles in the practice of artificial insemination by donors (AID) in China, in a culture characterised by traditional ethical values and disapproval of AID. The paper presents the ethical approach to AID treatment as established by the Reprodu...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2004.007831

    authors: Li LJ,Lu GX

    更新日期:2005-06-01 00:00:00

  • Wish-fulfilling medicine in practice: the opinions and arguments of lay people.

    abstract:BACKGROUND:Wish-fulfilling medicine appears to be on the rise. It can be defined as 'doctors and other health professionals using medical means (medical technology, drugs, and so on) in a medical setting to fulfil the explicitly stated, prima facie non-medical wish of a patient'. Some instances of wish fulfilling medic...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2013-101480

    authors: Asscher EC,Schermer M

    更新日期:2014-12-01 00:00:00

  • Veterinary surgeons' attitudes towards physician-assisted suicide: an empirical study of Swedish experts on euthanasia.

    abstract:AIM:To examine the hypothesis that knowledge about physician-assisted suicide (PAS) and euthanasia is associated with a more restrictive attitude towards PAS. DESIGN:A questionnaire about attitudes towards PAS, including prioritization of arguments pro and contra, was sent to Swedish veterinary surgeons. The results w...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2010.038901

    authors: Lerner H,Lindblad A,Algers B,Lynöe N

    更新日期:2011-05-01 00:00:00

  • Thinking clearly about the FIRST trial: addressing ethical challenges in cluster randomised trials of policy interventions involving health providers.

    abstract::The ethics of the Flexibility In duty hour Requirements for Surgical Trainees (FIRST) trial have been vehemently debated. Views on the ethics of the FIRST trial range from it being completely unethical to wholly unproblematic. The FIRST trial illustrates the complex ethical challenges posed by cluster randomised trial...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2017-104282

    authors: Horn AR,Weijer C,Hey SP,Brehaut J,Fergusson DA,Goldstein CE,Grimshaw J,Taljaard M

    更新日期:2018-09-01 00:00:00

  • From proband to provider: is there an obligation to inform genetic relatives of actionable risks discovered through direct-to-consumer genetic testing?

    abstract::Direct-to-consumer genetic testing is a growing phenomenon, fuelled by the notion that knowledge equals control. One ethical question that arises concerns the proband's duty to share information indicating genetic risks in their relatives. However, such duties are unenforceable and may result in the realisation of ant...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2020-106966

    authors: Parsons JA,Baker PE

    更新日期:2020-12-09 00:00:00

  • Can the Catholic Church agree to condom use by HIV-discordant couples?

    abstract::Does the position of the Roman Catholic Church on contraception also imply that the usage of condoms by HIV-discordant couples is illicit? A standard argument is to appeal to the doctrine of double effect to condone such usage, but this meets with the objection that there exists an alternative action that brings about...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2009.030767

    authors: Bovens L

    更新日期:2009-12-01 00:00:00

  • Patients' rights--why the Australian courts have rejected 'Bolam'.

    abstract::This point of view compares the issue of informed patient consent primarily as it operates in Australia and the United Kingdom. It affords an overview, also, of the applicable law in the United States and Canada. It particularly focuses on the legal test to be applied to patient consent as established in the Bolam cas...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.21.1.5

    authors: Kirby M

    更新日期:1995-02-01 00:00:00

  • Misled and confused? Telling the public about MMR vaccine safety. Measles, mumps, and rubella.

    abstract::The extraordinary events surrounding the measles, mumps, and rubella (MMR) vaccine in the United Kingdom have not only placed in jeopardy the use of this triple vaccine but have also spread concern to other parts of the world. Examination of the public's worry about MMR vaccine reveals they have been exposed to a rang...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.29.1.22

    authors: Clements CJ,Ratzan S

    更新日期:2003-02-01 00:00:00

  • Predictive genetic testing of children for adult-onset diseases and psychological harm.

    abstract::One of the central arguments given to resist testing currently healthy, asymptomatic children for adult-onset diseases is that they may be psychologically harmed by the knowledge gained from such tests. In this discussion I examine two of the most serious arguments: children who are tested may face limited futures, an...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2006.019802

    authors: Malpas PJ

    更新日期:2008-04-01 00:00:00

  • Conflict before the courtroom: challenging cognitive biases in critical decision-making.

    abstract::Conflict is an important consideration in the intensive care unit (ICU). In this setting, conflict most commonly occurs over the 'best interests' of the incapacitated adult patient; for instance, when families seek aggressive life-sustaining treatments, which are thought by the medical team to be potentially inappropr...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2020-106177

    authors: Johal HK,Danbury C

    更新日期:2020-07-06 00:00:00

  • Differences between death and dying.

    abstract::With so much attention being paid to the development and refinement of appropriate criteria and tests for death, little attention has been given to the broader conceptual issues having to do with its definition or with the relation of a definition to its criterion. The task of selecting the correct criterion is, howev...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.21.5.270

    authors: Bartlett ET

    更新日期:1995-10-01 00:00:00

  • Scientific misconduct from the perspective of research coordinators: a national survey.

    abstract:OBJECTIVE:To report results from a national survey of coordinators and managers of clinical research studies in the US on their perceptions of and experiences with scientific misconduct. METHODS:Data were collected using the Scientific Misconduct Questionnaire-Revised. Eligible responses were received from 1645 of 530...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2006.016394

    authors: Pryor ER,Habermann B,Broome ME

    更新日期:2007-06-01 00:00:00

  • Moral distress and moral residue experienced by transplant coordinators.

    abstract::Transplant coordinators play a pivotal role in the process of obtaining consent for live or dead donation of organs. The objective of the project is to unveil emotional experiences and ethical conduct of transplant coordinators using a qualitative research methodology. Ten transplant coordinators who have worked for m...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2019-105593

    authors: Tarabeih M,Bokek-Cohen Y

    更新日期:2020-07-28 00:00:00

  • The Groningen Protocol for newborn euthanasia; which way did the slippery slope tilt?

    abstract::In The Netherlands, neonatal euthanasia has become a legal option and the Groningen Protocol contains an approach to identify situations in which neonatal euthanasia might be appropriate. In the 5 years following the publication of the protocol, neither the prediction that this would be the first step on a slippery sl...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2013-101402

    authors: Verhagen AA

    更新日期:2013-05-01 00:00:00

  • Doctor's views on disclosing or withholding information on low risks of complication.

    abstract:BACKGROUND:More and more quantitative information is becoming available about the risks of complications arising from medical treatment. In everyday practice, this raises the question whether each and every risk, however low, should be disclosed to patients. What could be good reasons for doing or not doing so? This wi...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2005.014936

    authors: Palmboom GG,Willems DL,Janssen NB,de Haes JC

    更新日期:2007-02-01 00:00:00

  • What are we to make of the charge that human biological enhancement technologies are 'unnatural'?

    abstract::In popular lay discourse, objections to human biological enhancement technologies are sometimes expressed in terms of the charge that they are unnatural. This paper critiques the literal claim that seems to be presented here, namely that such technologies are in some ordinary sense 'unnatural' and that it follows from...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2018-104991

    authors: Miller PR

    更新日期:2019-02-01 00:00:00

  • Assessing risk/benefit for trials using preclinical evidence: a proposal.

    abstract::Moral evaluation of risk/benefit in early phase studies requires assessing the clinical promise of a candidate intervention using preclinical evidence. Yet, there is little to guide ethics committees, investigators, sponsors or other stakeholders morally charged with making these assessments ('evaluators'). In what fo...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2015-102882

    authors: Kimmelman J,Henderson V

    更新日期:2016-01-01 00:00:00

  • Should physicians fake diagnoses to help their patients?

    abstract::Are fake diagnoses and false or misleading certificates permissible means of helping patients? This question is examined in relation to four examples from Swedish health care: the sterilisation case, the asylum case, the virginity case, and the adoption case. We argue that both consequentialist and deontological ethic...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2006.018945

    authors: Helgesson G,Lynöe N

    更新日期:2008-03-01 00:00:00

  • Whatever happened to medical politics?

    abstract::This paper argues the case for coming to see 'medical politics' as a topic or subject within medical education. First, its absence is noted from the wide array of paramedical subjects (medical ethics, history of medicine, the medical humanities, etc) currently given attention in both the medical education literature a...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2010.041277

    authors: Emmerich N

    更新日期:2011-10-01 00:00:00

  • Unfinished feticide.

    abstract::A fetus may survive an intentional interference with its intrauterine environment (1) if gestational age is mistaken and the procedure of induced abortion does not kill the fetus, (2) if a change of heart takes place after abortifacient drugs are taken and the abortion does not proceed, and (3) if a high-multiple preg...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章,评审

    doi:10.1136/jme.16.2.61

    authors: Jansen RP

    更新日期:1990-06-01 00:00:00

  • Primary care confidentiality for Spanish adolescents: fact or fiction?

    abstract:BACKGROUND:By providing healthcare to adolescents, a major opportunity is created to help them cope with the challenges in their lives, develop healthy behaviour and become responsible healthcare consumers. Confidentiality is a major issue in adolescent healthcare, and its perceived absence may be the main barrier to a...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2005.011932

    authors: Pérez-Cárceles MD,Pereñiguez JE,Osuna E,Pérez-Flores D,Luna A

    更新日期:2006-06-01 00:00:00

  • Elderly patients' and residents' perceptions of 'the good nurse': a literature review.

    abstract::This article describes the findings of a mixed method literature review that examined the perceptions of elderly patients and residents of a good nurse in nursing homes, hospitals and home care. According to elderly patients and residents, good nurses are individuals who have the necessary technical and psychosocial s...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章,评审

    doi:10.1136/medethics-2011-100046

    authors: Van der Elst E,Dierckx de Casterlé B,Gastmans C

    更新日期:2012-02-01 00:00:00