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Indeterminacy and the principle of need

Artikel i vetenskaplig tidskrift
Författare Anders Herlitz
Publicerad i Theoretical Medicine and Bioethics
Volym 38
Nummer/häfte 1
Sidor 1-14
ISSN 1386-7415
Publiceringsår 2017
Publicerad vid Institutionen för filosofi, lingvistik och vetenskapsteori
Sidor 1-14
Språk English
Länkar doi.org/10.1007/s11017-016-9393-5
Ämnesord Principle of need, Priority setting, Health care rationing, Indeterminacy, health-care, priority, hybrid, Social Sciences - Other Topics, Social Issues, Biomedical Social, Sciences
Ämneskategorier Hälsovetenskaper, Annan samhällsvetenskap


The principle of need-the idea that resources should be allocated according to need-is often invoked in priority setting in the health care sector. In this article, I argue that a reasonable principle of need must be indeterminate, and examine three different ways that this can be dealt with: appendicizing the principle with further principles, imposing determinacy, or empowering decision makers. I argue that need must be conceptualized as a composite property composed of at least two factors: health shortfall and capacity to benefit. When one examines how the different factors relate to each other, one discovers that this is sometimes indeterminate. I illustrate this indeterminacy in this article by applying the small improvement argument. If the relation between the factors are always determinate, the comparative relation changes by a small adjustment. Yet, if two needs are dissimilar but of seemingly equal magnitude, the comparative relation does not change by a small adjustment of one of the factors. I then outline arguments in favor of each of the three strategies for dealing with indeterminacy, but also point out that all strategies have significant shortcomings. More research is needed concerning how to deal with this indeterminacy, and the most promising path seems to be to scrutinize the position of the principle of need among a plurality of relevant principles for priority setting in the health care sector.

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