Rationing and rationality: the cost of avoiding discrimination

Abstract

This paper discusses the difficulties of prioritizing healthcare resources in a way that is both rational and just. The authors argue that any system of priority setting must confront four unpalatable consequences: preference for early death, pointless violation of autonomy, disability discrimination, and cyclic preferences. They argue that the QALY-maximizing approach, while facing criticism for its discriminatory nature, is actually more plausible than the alternatives. The authors reject rights-based approaches and lottery solutions because they ultimately lead to cyclic preferences, which are deemed unacceptable due to their potential for irrational behavior. In conclusion, the authors demonstrate that there is no easy solution to the problem of health resource allocation and argue that the QALY system, despite its flaws, is a relatively sound approach. – AI-generated abstract