5 - Disability & age discrimination Flashcards
What is the disability discrimination objection, and upon which confusion is it based?
using cost-effectiveness analysis for allocating health care resources leads to unfair discrimination against people with disabilities. It discriminates because it leads to unequal treatment
value of a person vs the value of the quality of their lives - each person is of equal value, but not all lives are equally valuable
explain the social model of disability
disabilities are seen as mere differences between humans, but it is society’s reactions to it which make it disadvantageous. It recommendts to give priority to achieve greatest improvement in health-related quality of life
what does cost effectiveness rank within society?
ranks interventions and outcomes of treatments, pharma etc NOT PATIENTS
What is the connection between QALY and the old Oregon admin?
- initially rejected by federal government - goal was to broaden access so that all eligible residents of the state would be covered by Medicaid, many of whom had unmet health needs due to disabilities and chronic health conditions.
- rejection primarily based on inability to distinguish between value of life and value of quality of life
what connection do borsar-hirose make between justice and disability?
The authors argue that a disability, with a theoretically manageable but cost-ineffective intervention, isn’t a case of unfair discrimination but a distinct moral issue. They propose addressing it within healthcare priority setting, not anti-discrimination laws. Their solution involves modifying cost-effectiveness analysis through equity weighting, prioritizing benefits for those with severe health needs. This approach mitigates unfairness without categorizing it as discriminatory.
what is a moral problem with QALY and disability-discrimination?
It is possible that interventions for some disability have unfavorable cost-effectiveness ratios, and thus the people living with that disability would be disadvantaged because the interventions are not provided to them.
what is double-jeopardy?
Double jeopardy’ refers to a situation where individuals with pre-existing disabilities are disadvantaged twice by the QALY system: first, by their disability, and second, by receiving lower priority for medical treatment because their potential QALY gain is less compared to able-bodied individuals.
which ethical concerns does double jeopardy raise?
Singer and colleagues argue that this approach is ethically problematic as it discriminates against people with disabilities, effectively valuing their lives less than those of able-bodied individuals.
which two distinction do Kappel and Sandøe, cited by Singer et al., mke about compensatory justice and the comparison of QALY gains/losses?
- life-time view → concerns a whole life-time, should be considered in its entirety
this seems logical, but it also implies that, under certain circumstances, someone presently suffering less should be helped in preference to someone presently suffering more (which is counterintuitive) - present-time view → equality as something relevant to the present moment, value of lives based on distributing resources in a way so that all interests are fulfilled
which view is presented by singer et al, to reduce suffering
timeless view = minimise present and future efforts - it is seen to be unfair that those who are the victims of disaster should for that reason be put at a further disadvantage by resource allocation decisions.
what is Singer’s argument on disability discrimination?
o John harris said theres concern for disability discrimination but singer argues that theres no discrimination
o Argument in favour of qualy based health care rationing and appeal to the veil of ignorance. If ur placed behind the veil and u don’t know ur gender disability etc ppl would rationally choose the principle of maximizing health benefits
o Its morally justifiable to maximize health benefits regardless of having disability; thus even if qualy favours ppl without disabilities then its still ok
what does QALY-based rationing say abt disabilities?
§ The QUALY based rationing does not imply that the life of individuals with disability is less valuable than the life of individuals with no disability
o Disability is a loss in the health-related quality of life
§ Disability does not imply the low level of the overall quality of life
Explain Rawls’ Veil of Ignorance and how it applies to healthcare allocation
We can decide whether social arrangements are just by asking if they would be agreed to by rational egoists choosing from behind a veil of ignorance, ie choosing basis of healthcare allocation w/o knowing whether someone else will need other form of healthcare at some point in the future. It allows us to ignore disability and focusing purely on QALY and who needs healthcare the most
what are two critiques of the QALY framework?
- Bias Against Disabilities: The authors argue that QALYs inherently discriminate against people with disabilities, as these individuals may not achieve a ‘full’ QALY from health interventions due to their pre-existing lower quality of life.
- Utilitarianism and Equity: tension between utilitarian principles (maximizing overall health benefits) and equity considerations. While QALYs are efficient from a utilitarian perspective, they may conflict with societal values of fairness and equality.
what are Harris’ critiques of current allocation systems?
- systems for being biased against those in double jeopardy, arguing that they fail to meet the standards of fairness and equality.
- need for reevaluation of how healthcare resources are distributed, emphasizing the need to consider the moral weight of treating all individuals equitably.
