The Health Services Research Unit-HØKH, Akershus University Hospital (Ahus), Sykehusveien 25, Akershus Universitetssykehus HF, Postboks 1000, 1478, Lørenskog, Norway.
Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
Med Health Care Philos. 2023 Sep;26(3):413-423. doi: 10.1007/s11019-023-10155-x. Epub 2023 May 13.
Adaptation to illness, and its relevance for distribution in health care, has been the subject of vigorous debate. In this paper I examine an aspect of this discussion that seems so far to have been overlooked: that some illnesses are difficult, or even impossible, to adapt to. This matters because adaptation reduces suffering. Illness severity is a priority setting criterion in several countries. When considering severity, we are interested in the extent to which an illness makes a person worse-off. I argue that no plausible theory of well-being can disregard suffering when determining to what extent someone is worse-off in terms of health. We should accept, all else equal, that adapting to an illness makes the illness less severe by reducing suffering. Accepting a pluralist theory of well-being allows us to accept my argument, while still making room for the possibility that adaptation is sometimes, all things considered, bad. Finally, I argue that we should conceptualize adaptability as a feature of illness, and thereby account for adaptation on a group level for the purposes of priority setting.
疾病适应及其与医疗保健分配的相关性一直是激烈争论的主题。在本文中，我考察了这一讨论中似乎迄今为止被忽视的一个方面：有些疾病难以甚至不可能适应。这很重要，因为适应可以减轻痛苦。疾病严重程度是几个国家的优先事项设定标准。在考虑严重程度时，我们关注的是疾病使一个人状况恶化的程度。我认为，在确定一个人在健康方面的恶化程度时，任何合理的幸福理论都不能忽视痛苦。我们应该接受，在其他条件相同的情况下，通过减轻痛苦来适应疾病会使疾病的严重程度降低。接受幸福的多元理论使我们能够接受我的论点，同时仍然为适应有时被认为是不利的可能性留出空间。最后，我认为我们应该将适应能力概念化为疾病的一个特征，并据此在群体层面上为优先事项设定考虑适应问题。
