Ethical Issues in Resource Allocation, Research, and New Product Development

Ethical dilemmas arising in setting priorities among interventions and among individuals in need of care are most acute when needs are great and resources few. This chapter from the Disease Control Priorities in Developing Countries 2nd edition addresses some of these concerns, identifying some of the principal ethical issues that arise in the development and allocation of effective interventions for developing countries and discussing some alternative resolutions.

Resource allocation in health and elsewhere should satisfy two main ethical criteria.

1. It should be cost-effective—limited resources for health should be allocated to maximize the health benefits for the population served. Cost-effectiveness is not merely an economic concern, because improving people's health and well-being is a moral concern, and an allocation of resources that is not cost-effective produces fewer benefits than would have been possible with a different allocation. Producing more rather than fewer benefits for people is one important ethical consideration in evaluating actions and social policies.
2. The allocation should be equitable or just; equity is concerned with the distribution of benefits and costs to distinct individuals or groups. The maximization of benefits, which is associated with the general philosophical moral theory of utilitarianism or consequentialism, however, is routinely criticized for ignoring those considerations. Equity in health care distribution is complex and embodies several distinct moral concerns or issues that this chapter delineates. There is no generally accepted methodology comparable to CEA for determining how equitable a distribution is; nevertheless, allocations are unsatisfactory if equity considerations are ignored. Efficiency and equity can sometimes coincide.

The discussion in this chapter accepts that CEA identifies one important ethical criterion in evaluating health care interventions—producing the most benefits possible for individuals served by those interventions—and then focuses on the other ethical criterion of ensuring equitable distribution of those benefits. This chapter considers two types of equity issues: first, those that arise in the general construction of a CEA—that is, in determining the form of a CEA; second, those that arise in the use of the results of a CEA for resource allocation in the health sector.