Norman Daniels and James Sabin have recently argued that when managed care organizations decide to limit access to beneficial medical services, the reasoning behind their decisions must be made public to ensure legitimacy and fairness. While Daniels and Sabin acknowledge that publicity for limit-setting decisions might undermine societal values such as the sanctity of life, they do not consider the merits of such an objection. That is my goal in this paper. I maintain that publicity for limit-setting decisions will undermine societal values most clearly if the reasoning behind such decisions is some sort of utilitarian-inspired cost-benefit analysis but even if such decisions involve more sophisticated forms of moral reasoning. First, I briefly describe limit-setting decisions and why they are often controversial. Next, I show how societal values could be undermined by publicity of limit-setting decisions. To elucidate the problem, I consider more generally why utilitarianism fails the publicity requirement. Thus, I claim that, insofar as limit-setting decisions possess a utilitarian basis, limit-setting decisions also fail the publicity requirement. Furthermore, even if limit-setting decisions could be given some other moral-theoretic basis, I argue that they will likely face similar problems. Limit-setting decisions can be made public without undermining societal values only if the basis for such decisions eschews any appeal to moral theory and remains thoroughly particularistic. Or so I argue in the final section of the paper.
Learning Objectives: During this session, the speaker will discuss a recent proposal to democratize and publicize the rationing decisions of managed care organizations. Specifically, the presentation will focus on the concern that publicizing such decisions and their rationale can undermine societal values such as the respect for life. Attendees at this session should gain greater understanding of the potential social costs of making rationing decisions public and how such costs might be avoided
Keywords: Rationing, Public Policy
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.