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Social justice and public health
Published in Sridhar Venkatapuram, Alex Broadbent, The Routledge Handbook of Philosophy of Public Health, 2023
The pattern or basis of distribution corresponds to the varying criteria used to determine how to distribute the currency of justice. Of particular significance to theories of justice in public health are distributive principles of maximization, equality, priority, and sufficiency. The principle of maximization requires that the currency of justice be maximized irrespective of how it is distributed within or between groups. Maximization is a key component of utilitarianism—a set of theories that propose the right course of action is that which tends to maximize the greatest utility for the greatest number of people (Sinnott-Armstrong 2015). Utilitarianism is the paradigm example of consequentialism, where outcomes of actions are considered to be the only factor of moral relevance. Which outcomes are valued (for example, pleasure, happiness, preference satisfaction, health status, or life expectancy) distinguishes many forms of utilitarianism (Bellefleur and Keeling 2016; Lyons 1965). In its most basic form, utilitarianism as a conception of justice establishes that individuals have claims of justice based on (rule) utilitarian grounds (Harsanyi 1985). As such, a society (or social institutions) may be considered just when it is arranged so as to achieve the greatest net balance of utility for all individuals (Mill 1962 [1861]). John Stuart Mill, a prominent figure in utilitarian philosophy, argues that utility (in his theory of utilitarianism) is “the highest abstract standard of social and distributive justice” (Mill 1962: 318).
Principles of Iterative Reconstruction for Emission Tomography
Published in Michael Ljungberg, Handbook of Nuclear Medicine and Molecular Imaging for Physicists, 2022
Now we seek the θj which maximizes the likelihood, given mi observed counts. The maximization is much simpler if we first take the natural logarithm. Taking the logarithm (which is a monotonic function) will not alter the location of the maximum of the function, so it is a safe simplification which will not affect our maximization:
The health economics of osteoporosis and estrogen replacement therapy
Published in Barry G. Wren, Progress in the Management of the Menopause, 2020
A further level of complexity is to consider a cost—utility analysis which involves an assessment of the quality of life with the aim of maximizing it; the units are cost per quality-adjusted life-year gained. The advantage of this approach is that health care is directed towards the maximization of quality as well as quantity of life. The disadvantage of this approach is that quality of life is, according to its very nature, subjective so that few people agree on the factors constituting quality of life. This becomes a particular problem when quality comes to he measured. A variety of approaches have been developed, all of which are dependent on questionnaires designed to determine the value that individuals put on a particular disease state. This may be done by asking how many years of life an individual would forgo to avoid the disease state in question (time trade-off). Alternatively, questionnaires have been developed, for example the Short Form 36 (SF 36), which include evaluation of a variety of quality-of-life ‘domains’. Other questionnaires include the Nottingham Health Profile and Euroquol. Although comprehensive, these questionnaires are often not sensitive or specific enough to detect the impact of a specific disease. Thus disease-specific questionnaires have been developed.
QALYs and ambulatory status: societal preferences for healthcare decision making
Published in Journal of Medical Economics, 2022
Lorna L. Freath, Alistair S. Curry, David M. W. Cork, Ivana F. Audhya, Katherine L. Gooch
QALYs have been described as denying that the life and health of each citizen is as important as that of any other, using the concept of double jeopardy9. The first jeopardy occurs where people with disability have lower ranking quality of life than those without disability, as measured by utilities. The second jeopardy occurs when people with disability then potentially face lower prioritization in QALY-based healthcare allocation9. The QALY maximization principle argues that healthcare decision makers should “implement the course of action which results in more QALYs than any alternative”10. QALY maximization can inadvertently lead to inequitable assessments among patients11; rather than being used to measure outputs of healthcare or as evidence in the choice of rival therapies, QALYs would be used to determine which groups of patients would get priority and often, which would get treated at all11. QALY maximization does not disadvantage people with severe disability if a disability can be reversed by treatment. However, when an underlying ambulatory disability cannot be reversed by treatment, life extension will represent a lower QALY gain, and thus a treatment will be less cost-effective compared with the same treatment for patients without disability. Patients can therefore be considered to experience double jeopardy. This may have concerning implications for treatment access decisions relying on QALY-based cost-effectiveness analyses, where there is comparison of the cost-effectiveness of an intervention against an explicit threshold.
To Procure or Not to Procure: Hospitals Face Significant Ethical Dilemmas Regarding Organ Donation During the COVID-19 Pandemic
Published in The American Journal of Bioethics, 2020
Jordan Potter, Jessica Ginsberg, Jason Lesandrini, Amy Andrelchik
While both (a) the nature and relationship of the benefit to the recipient and (b) whether this benefit applies to a patient or a non-patient are ethically relevant considerations–and would likely serve as a “tiebreaker” in favor of the hospital’s patient in cases of similar levels of benefit–given the context of pandemic-related resource rationing the weightiest ethical consideration still involves the maximization of benefits, especially in terms of lives saved. This is consistent with the emerging dominant ethical framework for scarce resource allocation during the COVID-19 pandemic, which holds that while there are multiple relevant guiding ethical principles to inform ethical scarce resource allocation, the maximization of benefit and lives saved is the most important of these guiding ethical principles and should be prioritized (Emanuel et al. 2020, 2051–2052).
Determining treatment intensity in elderly patients with multiple myeloma
Published in Expert Review of Anticancer Therapy, 2018
Marco Salvini, Mattia D’Agostino, Francesca Bonello, Mario Boccadoro, Sara Bringhen
Before addressing the topic of dose tailoring according to patients’ frailty, it is necessary to mention that current recommendations about this matter are based on expert opinion, single center experiences, or deduced by the analysis of results of clinical trials designed for other purposes. Furthermore, for many new drugs – such as ixazomib, elotuzumab, or daratumumab – there are no data available to support treatment adjustment upon frailty. Therefore, there is an urgent need to design focused trials that may offer evidence sufficiently strong to elaborate supported guidelines. Data presented in the preceding paragraphs show that many therapeutic options are potentially available for patients ≥65 years old. For this very reason, defining the patient status is a key strategy for the selection of the appropriate treatment and the maximization of the benefit/risk ratio. Very fit patients aged 65–70 years might be eligible for HDT-ASCT. Independently of chronological age, patients with comorbidities and/or frail should be treated with less intensive therapies [26].