Methods of Economic Evaluation: What are the Ethical Implications for Healthy Public Policy?

Decision making in healthy public policy,¹ as in all policy areas, increasingly involves taking economic efficiency into consideration. Efficiency is the extent to which sought-after benefits can be obtained for the lowest possible cost, and the tools that measure it are economic evaluations. Efficiency is, however, but one of the many possible criteria according to which policy options can be judged. There is a range of other values and objectives that we may want policies to fulfill. Deciding between at times divergent values is an ethical enterprise, and the use of economic evaluations can have profound ethical implications.

The first paper in this series introduced some of the general ethical issues that arise when economic evaluations are applied in healthy public policy.² While there are a number of diverse methods of economic evaluation, all of them share several fundamental, underlying assumptions that have ethical implications. Most prominent among these are the assumptions of individualism in methodology and utilitarianism in ethics. Methodological individualism is the assumption that, simply put, all “we’s” can be reduced to collections of “I’s”; in other words, all social phenomena can be explained with reference solely to the actions and beliefs of individual human beings. Such an assumption tends to promote values such as individual autonomy and can conflict with values such as social solidarity and community empowerment that are based on a more holistic understanding of communities.