gms | German Medical Science

Introduction: Dealing with ethics in health economics on theoretical grounds seems not well established. Classical welfare economics tries to capture ethical values such as distributive justice through incorporating them into the preference structure, i.e. by using a utility measure for them. This approach is extended by extra-welfarism which allows for ethical values to be incorporated as such. Examples for non-utility values are capabilities or characteristics such as health. We want to deepen this approach in health economics by formulating a theoretical justification based on the philosophy of Charles Taylor.

Material and Methods: The theoretical exposition starts with the question why we do not use established theories such as those of Kant or Rawls for the justification of ethical values in health economics. They tend to give room for behaviour without values. In contrast to this, we reconstruct existing structures and values in the domain of health economics and suppose with Charles Taylor that human behaviour is always value-driven. The main goal of this approach is to unearth unacknowledged values in order to make clear that they represent structures of expectation which can be chosen or modified deliberately.

Results: Charles Taylor deals with the question of unacknowledged mainsprings of society and science. He argues that economic theory is among other things based on ethical decisions, which he calles strong valuations. Strong valuations are measures for desires and decisions. They are cherished as such without any pragmatic attitude towards them and they represent qualitative distinctions (i.e. binary codes like worthy/unworthy, good/bad), thereby giving fundamental orientations. Examples for strong values are: affirmation of ordinary life (vs. ascetism); human dignity (equality vs. hierarchical distinctions); rational self-determination (individualism vs. collectivism).

Conclusions: Extra-welfarism is not yet very well established in health economics. A theoretical base for considering ethical values in economics in general could change this state. But for a general shift several foundations have to be laid: availability of sources of funding; conferences and meetings devoted to the new approach and institutions who give credence to the new paradigm.