Toward a Pellegrino-inspired theory of value in health care
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Contemporary medical practice and health policy are increasingly animated by the concept of providing high value care. Nevertheless, there can be disagreements about how value is defined and from whose perspective. Individual patients suffering from terminal cancer, for example, may have a different perception of the value of an expensive chemotherapy when compared to health policymakers, insurers, or others responsible for the financial solvency of health care organizations. Thus it seems reasonable to ask what is meant by “value” in high value care. In light of Edmund Pellegrino’s significant contributions to the philosophy of medicine, medical humanities, and bioethics, it seems equally reasonable to examine how he might answer it. This paper describes a Pellegrino-inspired theory of (health care) value that is instrumental, agent relative, and pluralistic. It then compares and contrasts this to the contemporary view and argues that only when individual patients incorporate concern for societal-level value into their conceptions of the highest good can the Pellegrino-inspired and contemporary views of value be reconciled.
KeywordsHigh value care Value theory Edmund Pellegrino
The author is grateful to the participants at the John Collins Harvey Lecture and 5th Annual Pellegrino Seminar, held March 1–2, 2018, at Georgetown University (Washington, DC), for their thoughtful comments and questions on a prior version of this paper. As neither a value theorist nor a Pellegrino scholar, the opportunity to delve deeply into Pellegrino’s work and meet his family members is one that has been treasured. The author also thanks Marie Stratton for her assistance in manuscript preparation.
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