IDEAS home Printed from https://ideas.repec.org/a/sae/medema/v28y2008i5p763-772.html
   My bibliography  Save this article

Beyond Utilitarianism: A Method for Analyzing Competing Ethical Principles in a Decision Analysis of Liver Transplantation

Author

Listed:
  • Michael L. Volk

    (Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, VA Health Services Research and Development Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan)

  • Anna S. F. Lok

    (Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor)

  • Peter A. Ubel

    (Division of General Internal Medicine, University of Michigan, Ann Arbor, Center for Behavioral and Decision Sciences in Medicine, University of Michigan, Ann Arbor, VA Health Services Research and Development Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan)

  • Sandeep Vijan

    (Division of General Internal Medicine, University of Michigan, Ann Arbor, VA Health Services Research and Development Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan)

Abstract

Background: The utilitarian foundation of decision analysis limits its usefulness for many social policy decisions. In this study, the authors examine a method to incorporate competing ethical principles in a decision analysis of liver transplantation for a patient with acute liver failure (ALF). Methods. A Markov model was constructed to compare the benefit of transplantation for a patient with ALF versus the harm caused to other patients on the waiting list and to determine the lowest acceptable 5-y posttransplant survival for the ALF patient. The weighting of the ALF patient and other patients was then adjusted using a multiattribute variable incorporating utilitarianism, urgency, and other principles such as fair chances. Results. In the base-case analysis, the strategy of transplanting the ALF patient resulted in a 0.8% increase in the risk of death and a utility loss of 7.8 quality-adjusted days of life for each of the other patients on the waiting list. These harms cumulatively outweighed the benefit of transplantation for an ALF patient having a posttransplant survival of less than 48% at 5 y. However, the threshold for an acceptable posttransplant survival for the ALF patient ranged from 25% to 56% at 5 y, depending on the ethical principles involved. Discussion. The results of the decision analysis vary depending on the ethical perspective. This study demonstrates how competing ethical principles can be numerically incorporated in a decision analysis.

Suggested Citation

  • Michael L. Volk & Anna S. F. Lok & Peter A. Ubel & Sandeep Vijan, 2008. "Beyond Utilitarianism: A Method for Analyzing Competing Ethical Principles in a Decision Analysis of Liver Transplantation," Medical Decision Making, , vol. 28(5), pages 763-772, September.
    • Handle: RePEc:sae:medema:v:28:y:2008:i:5:p:763-772
    DOI: 10.1177/0272989X08316999
    as

    Download full text from publisher

    File URL: https://journals.sagepub.com/doi/10.1177/0272989X08316999
    Download Restriction: no
    File URL: https://libkey.io/10.1177/0272989X08316999?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Julie Ratcliffe, 2000. "Public preferences for the allocation of donor liver grafts for transplantation," Health Economics, John Wiley & Sons, Ltd., vol. 9(2), pages 137-148, March.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Robson, Matthew & O’Donnell, Owen & Van Ourti, Tom, 2024. "Aversion to health inequality — Pure, income-related and income-caused," Journal of Health Economics, Elsevier, vol. 94(C).
    2. Colin Green & Karen Gerard, 2009. "Exploring the social value of health‐care interventions: a stated preference discrete choice experiment," Health Economics, John Wiley & Sons, Ltd., vol. 18(8), pages 951-976, August.
    3. Marta Trapero-Bertran & Beatriz Rodríguez-Martín & Julio López-Bastida, 2019. "What attributes should be included in a discrete choice experiment related to health technologies? A systematic literature review," PLOS ONE, Public Library of Science, vol. 14(7), pages 1-15, July.
    4. Kara Hanson & Barbara McPake & Pamela Nakamba & Luke Archard, 2005. "Preferences for hospital quality in Zambia: results from a discrete choice experiment," Health Economics, John Wiley & Sons, Ltd., vol. 14(7), pages 687-701, July.
    5. Adele Diederich & Jeannette Winkelhage & Norman Wirsik, 2011. "Age as a Criterion for Setting Priorities in Health Care? A Survey of the German Public View," PLOS ONE, Public Library of Science, vol. 6(8), pages 1-10, August.
    6. Paul Dolan & Rebecca Shaw & Aki Tsuchiya & Alan Williams, 2005. "QALY maximisation and people's preferences: a methodological review of the literature," Health Economics, John Wiley & Sons, Ltd., vol. 14(2), pages 197-208, February.
    7. Jeannette Winkelhage & Adele Diederich, 2012. "The Relevance of Personal Characteristics in Allocating Health Care Resources—Controversial Preferences of Laypersons with Different Educational Backgrounds," IJERPH, MDPI, vol. 9(1), pages 1-21, January.
    8. Rodríguez-Míguez, Eva & Herrero, Carmen & Pinto-Prades, José Luis, 2004. "Using a point system in the management of waiting lists: the case of cataracts," Social Science & Medicine, Elsevier, vol. 59(3), pages 585-594, August.
    9. John McKie & Bradley Shrimpton & Jeff Richardson & Rosalind Hurworth, 2011. "The monetary value of a life year: evidence from a qualitative study of treatment costs," Health Economics, John Wiley & Sons, Ltd., vol. 20(8), pages 945-957, August.
    10. Carina Oedingen & Tim Bartling & Axel C. Mühlbacher & Harald Schrem & Christian Krauth, 2019. "Systematic Review of Public Preferences for the Allocation of Donor Organs for Transplantation: Principles of Distributive Justice," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 12(5), pages 475-489, October.
    11. Jennifer Whitty & Sharyn Rundle-Thiele & Paul Scuffham, 2012. "Insights from triangulation of two purchase choice elicitation methods to predict social decision making in healthcare," Applied Health Economics and Health Policy, Springer, vol. 10(2), pages 113-126, March.
    12. Dolan, Paul & Shaw, Rebecca, 2004. "A note on a discussion group study of public preferences regarding priorities in the allocation of donor kidneys," Health Policy, Elsevier, vol. 68(1), pages 31-36, April.
    13. Schwappach, David L.B. & Strasmann, Thomas J., 2006. ""Quick and dirty numbers"?: The reliability of a stated-preference technique for the measurement of preferences for resource allocation," Journal of Health Economics, Elsevier, vol. 25(3), pages 432-448, May.
    14. David L.B. Schwappach, 2003. "Does it matter who you are or what you gain? an experimental study of preferences for resource allocation," Health Economics, John Wiley & Sons, Ltd., vol. 12(4), pages 255-267, April.
    15. Gyrd-Hansen, Dorte, 2004. "Investigating the social value of health changes," Journal of Health Economics, Elsevier, vol. 23(6), pages 1101-1116, November.
    16. repec:cup:judgdm:v:5:y:2010:i:1:p:11-20 is not listed on IDEAS
    17. Collewet, Marion & Koster, Paul, 2023. "Preference estimation from point allocation experiments," Journal of choice modelling, Elsevier, vol. 48(C).
    18. Jeff Richardson & Angelo Iezzi & Gang Chen & Aimee Maxwell, 2017. "Communal Sharing and the Provision of Low-Volume High-Cost Health Services: Results of a Survey," PharmacoEconomics - Open, Springer, vol. 1(1), pages 13-23, March.
    19. Joanna Coast & Hareth Al‐Janabi & Eileen J. Sutton & Susan A. Horrocks & A. Jane Vosper & Dawn R. Swancutt & Terry N. Flynn, 2012. "Using qualitative methods for attribute development for discrete choice experiments: issues and recommendations," Health Economics, John Wiley & Sons, Ltd., vol. 21(6), pages 730-741, June.
    20. Mira Johri & Laura J. Damschroder & Brian J. Zikmund‐Fisher & Peter A. Ubel, 2005. "The importance of age in allocating health care resources: does intervention‐type matter?," Health Economics, John Wiley & Sons, Ltd., vol. 14(7), pages 669-678, July.
    21. Richardson, Jeff & Sinha, Kompal & Iezzi, Angelo & Maxwell, Aimee, 2012. "Maximising health versus sharing: Measuring preferences for the allocation of the health budget," Social Science & Medicine, Elsevier, vol. 75(8), pages 1351-1361.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:sae:medema:v:28:y:2008:i:5:p:763-772. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: SAGE Publications (email available below). General contact details of provider: .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.