Priority setting in healthcare: from arbitrariness to societal values
Résumé
This paper develops an account of the normative basis of priority setting
in health care as combining the values which a given society holds for the
common good of its members, with the universal provided by a principle of
common humanity. We discuss national differences in health basket in Europe
and argue that health care decision-making in complex social and moral
frameworks is best thought of as anchored in such a principle by drawing on the
philosophy of need. We show that health care needs are ethically ‘thick’ needs
whose psychological and social construction can best be understood in terms of
David Wiggins’s notion of vital need: a person’s need is vital when failure to meet
it leads to their harm and suffering. The moral dimension of priority setting which
operates across different societies’ health care systems is located in the demands
both of and on any society to avoid harm to its members.