Real freedom for all turtles in Sugarscape? - Presses universitaires ...

S c h o k k a e r t – P h i l o s o p h e r s a n d t a b o o t r a d e - o f f s i n h e a l t h c a r e 309fine theories of Daniels and Dworkin. Yet, I do believe that a better insightinto the psychological mechanisms and cognitive and emotional biases thatinfluence our ways of reasoning may help to get a better perspective on therelative value of different ethical theories. In the case of priority setting inhealth care, they should warn us for the fact that theories may be attractivefor the wrong reasons, i.e. because they make decisions more bearable ratherthan leading to fairer outcomes.For the problem of priority setting, I think we should have the courage tofeel uneasy. Since we cannot escape making taboo trade-offs, we must beopen about them. It is crucially important to set up fair decision procedures– but we should also have the courage to think explicitly about what arevalid substantive ethical arguments in the context of priority setting. Andwe should be aware that a “clean” hypothetical approach can at best be astarting point. Denying treatment to patients with a rare disease is not ahypothetical choice – nor is the decision to spend 40% of our nationalproduct to health care. 3 What matters at the end, is the final ex postdistributionof income and health.ReferencesARROW, K. (1963), 'Uncertainty and the welfare economics of medical care',American Economic Review, 53: 941-973.DANIELS, N. (2008), Just health. Meeting health needs fairly, Cambridge: CambridgeUniversity Press.DANIELS, N. & SABIN, J. (2008), Setting limits fairly: learning to share resources forhealth (2nd ed.), Oxford: Oxford University Press.DWORKIN, R. (2000), Sovereign virtue, Cambridge: Cambridge University Press.FISKE, A. & TETLOCK, P. (1997), 'Taboo trade-offs: reactions to transactions thattransgress the spheres of justice', Political Psychology, 18: 255-297.FLEURBAEY, M. (2010), 'Assessing risky social decisions', Journal of Political Economy,118: 649-680.GRUSKIN, S. & DANIELS, N. (2008), 'Justice and human rights: priority setting andfair deliberative process', American Journal of Public Health, 98: 1573-1577.HALL, R. & JONES, C. (2007), 'The value of life and the rise in health spending',Quarterly Journal of Economics, 112: 39-72.TETLOCK, P. (2003), 'Thinking the unthinkable: sacred values and taboo cognitions',Trends in cognitive sciences, 7: 320-324.VAN PARIJS, P. (1996), Refonder la solidarité, Paris: Editions du Cerf.3According to Hall and Jones (2007), this is the welfare optimal share of health careexpenditures in the US for 2050.