Considering the Use of Cost-Benefit Analysis in Biomedical Ethics

Sahar Akhtar, Duke University

Winner, 2003 essay contest

The field of bioethics, as with most areas of applied ethics, is laden with propositions about the intrinsic value of life, treating persons as ends in themselves, and bestowing priority to individual rights and autonomy. These ideals are important because they signify a society?s unwillingness to promote the common good at the expense of the individual. They also place emphasis on values, in particular respect for autonomy, that have historically been undervalued by various health-care practices. Furthermore, they offer goals to which to aspire. On the other hand, these values must also be vulnerable to evaluation, criticism and comparison with other significant values. Although this may seem obvious to some, few authors in the bioethics literature seem to fully appreciate the implications of the condition of scarcity. This is something which economists have taken seriously enough that they have built the condition into theories, both individual-based and public-based. Given that resources and time are both limited, we are often, indeed, always according to some views, forced to choose between competing values, claims, and preferences. However, economists are sometimes too quick to accept that trade-offs must be made, and a result of this may be that the ?costs? of adopting any one choice, which may be other significant values, are too easily written-off as being unavoidable. Both approaches seem to be incomplete in an important way. I argue that the requirement of trading off one value for another needs to be taken more seriously in bioethics. In addition, though, I also argue that there is the simultaneous need for identifying what would be intrinsically and absolutely valuable under ideal conditions?that is, in a world of abundance.

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