Utilities vs. Rights to Publicly Provided Goods: Arguments and Evidence from Health-Care Rationing

This paper challenges the QALY maximizing approach to rationing health care on the grounds of the consequentialist (and sometimes approximately utilitarian) moral framework on which it is based. An alternative methodological approach is suggested and, in addition to consequences, four normative determinants of health care entitlements are identified: rights, public opinion, social contracts and community values. Survey evidence is presented which shows support for these alternative frameworks and a rejection of consequentialism. The paper suggests that a (if not the) major challenge facing the designers of rationing guidelines is that of pluralism, i.e. the need to integrate considerations from a set of frameworks.