Health Care Analysis

, Volume 9, Issue 2, pp 187-211

First online:

The Ethics of Aggregation and Hormone Replacement Therapy

  • Anne Drapkin LyerlyAffiliated withThe Bioethics Institute, Johns Hopkins University and The Kennedy Institute of Ethics, Georgetown University Email author 
  • , Evan R. MyersAffiliated withDepartment of Obstetrics and Gynecology, Duke University
  • , Ruth R. FadenAffiliated withThe Bioethics Institute, Johns Hopkins University and The Kennedy Institute of Ethics, Georgetown University

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The use of aggregated quality of life estimatesin the formation of public policy and practiceguidelines raises concerns about the moralrelevance of variability in values inpreferences for health care. This variabilitymay reflect unique and deeply held beliefs thatmay be lost when averaged with the preferencesof other individuals. Feminist moral theorieswhich argue for attention to context andparticularity underline the importance ofascertaining the extent to which differences inpreferences for health states revealinformation which is morally relevant toclinicians and policymakers. To facilitatethese considerations, we present an empiricalstudy of preferences for the timing andoccurrence of health states associated withhormone replacement therapy (HRT). Sixteenwomen between the ages of 45 and 55 wereenrolled in this pilot study. Theirpreferences regarding five health statesassociated with HRT (menopausal symptoms, sideeffects of HRT, breast cancer, myocardialinfarction, and osteoporosis) were assessed inquantitative terms known as utilities. Twostandard methods, the visual analog scale (VAS) and the standard gamble (SG), were used toassess utility and time preference (calculatedas a discount rate). The wide variability ofresponses underlines the importance oftailoring health care to individual women'spreferences. Policy guidelines whichincorporate utility analysis must recognize thenormative limitations of aggregatedpreferences, and the moral relevance ofindividual conceptions of health.

cost-effective analysis decision analysis distributive justice feminist theory hormone replacement therapy menopause patient preferences time preference utility women