Herlitz Anders
Harvard University, Boston, Massachusetts, USA.
Institute of Futures Studies, Stockholm, Sweden.
J Med Philos. 2018 Nov 17;43(6):724-745. doi: 10.1093/jmp/jhy026.
This article argues that values that apply to health care allocation entail the possibility of "spectrum arguments," and that it is plausible that they often fail to determine a best alternative. In order to deal with this problem, a two-step process is suggested. First, we should identify the Strongly Uncovered Set that excludes all alternatives that are worse than some alternatives and not better in any relevant dimension from the set of eligible alternatives. Because the remaining set of alternatives often contain more than one element, we need some complementary method of selecting a unique alternative. In order to address this issue, I suggest that we must invoke caps on the values that are used to evaluate alternatives, and that these caps must be grounded in collective commitments.
本文认为，适用于医疗保健资源分配的价值观会引发“频谱论证”的可能性，并且这些价值观往往无法确定最佳选择，这似乎是合理的。为了解决这个问题，建议采用两步法。首先，我们应确定强未覆盖集，该集合从合格替代方案集中排除所有比某些替代方案更差且在任何相关维度上都没有更好的替代方案。由于剩余的替代方案集通常包含多个元素，我们需要一些补充方法来选择唯一的替代方案。为了解决这个问题，我建议我们必须对用于评估替代方案的价值观设定上限，并且这些上限必须基于集体承诺。
