Institutional design and moral conflict in health care priority-setting

AbstractPriority-setting policy-makers often face moral and political pressure to balance the conflicting motivations ofefficiency andrescue/non-abandonment. Using the conflict between these motivations as a case study can enrich the understanding of institutional design in developed democracies. This essay presents a cognitive-psychological account of the conflict between efficiency and rescue/non-abandonment in health care priority-setting. It then describes three sets of institutional arrangements —in Australia, England/Wales, and Germany, respectively—that contend with this conflict in interestingly different ways. The analysis yields at least three implications for institutional design in developed democracies: (1) indeterminacy at the level of moral psychology can increase the probabil ity of indeterminacy at the level of institutional design; (2) situational constraints in effect require priority-setting policy-makers to adopt normative-moral pluralism; and (3) the U.S. health care system may be in ananti-priority-setting equilibrium.
Source: Medicine, Healthcare and Philosophy - Category: Medical Ethics Source Type: research