Valuing health: against the ethical view

Abstract

Health is often valued by its contribution to well-being. The most common way to establish values for health states is through eliciting a sample population’s preferences among states. The evidential view supports preferences based on the idea that preferences provide reliable indicators of well-being. The ethical view takes eliciting preferences to show proper respect for persons. I address the ethical view. In this thesis, I explain the process of valuing health states and describe the evidential and ethical views. I explain how preference-based measures are supposed to show respect for persons, and that respect for persons is shown by respecting autonomous preferences, and only autonomous preferences. I argue that health state preferences are not autonomous preferences, and as a result, preference-based measures do not show respect for persons. Thus, they are not actually supported by the ethical view. I explain the consequences of this argument for health valuation, suggesting that this gives us a reason to prefer methods that value health on other bases, e.g. through opportunity or capability. I also suggest that this has consequences for how we should think about autonomous choice in healthcare, and propose that bioethics needs further investigation into the processes of patient decision-making.