Disease prioritarianism: a flawed principle
- 202 Downloads
Disease prioritarianism is a principle that is often implicitly or explicitly employed in the realm of healthcare prioritization. This principle states that the healthcare system ought to prioritize the treatment of disease before any other problem. This article argues that disease prioritarianism ought to be rejected. Instead, we should adopt ‘the problem-oriented heuristic’ when making prioritizations in the healthcare system. According to this idea, we ought to focus on specific problems and whether or not it is possible and efficient to address them with medical means. This has radical implications for the extension of the healthcare system. First, getting rid of the binary disease/no-disease dichotomy implicit in disease prioritarianism would improve the ability of the healthcare system to address chronic conditions and disabilities that often defy easy classification. Second, the problem-oriented heuristic could empower medical practitioners to address social problems without the need to pathologize these conditions. Third, the problem-oriented heuristic clearly states that what we choose to treat is a normative consideration. Under this assumption, we can engage in a discussion on de-medicalization without distorting preconceptions. Fourth, this pragmatic and de-compartmentalizing approach should allow us to reconsider the term ‘efficiency’.
KeywordsMedical ethics Medicalization Disease Prioritization Cost-benefit analysis
- Boorse, Christopher. 2011. Concepts of health and disease. In Philosophy of medicine, ed. Fred Gifford, 16–13. North Holland: Elsevier.Google Scholar
- Caplan, Arthur L., James J. McCartney, and Dominic A. Sisti. 2004. Health, disease, and illness: concepts in medicine. Washington, D.C.: Georgetown University Press.Google Scholar
- Greenberg, Gary. 2010. Manufacturing depression: the secret history of an american disease. New York: Simon & Schuster.Google Scholar
- Illich, Ivan. 1982. Medical nemesis: the expropriation of health. New York: Pantheon Books.Google Scholar
- Juth, Niklas. 2015. Challenges for principles of need in health care. Health Care Analysis 23(1): 73–87.Google Scholar
- Kessler, Ronald C., Patricia Berglund, Olga Demler, Robert Jin, Kathleen R. Merikangas, and Ellen E. Walters. 2005. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62(6): 593–602. doi: 10.1001/archpsyc.62.6.593.CrossRefGoogle Scholar
- Larochelle, Sébastien, Louis Diguer, Olivier Laverdière, Dominick Gamache, Paul Samuel Greenman, and Jean Descôteaux. 2010. Psychological dimensions of antisocial personality disorder as predictors of psychotherapy noncompletion among sexual offenders. Bulletin of the Menninger Clinic 74(1): 1–28. doi: 10.1521/bumc.2010.74.1.1.CrossRefGoogle Scholar
- Larsson, Jan. 2007. Prioriteringar i hälso- och sjukvården Socialstyrelsen analys och slutsatser utifrån rapporten “Vårdens alltför svåra val?”. 2007-103-4. Socialstyrelsen. http://www.socialstyrelsen.se/Lists/Artikelkatalog/Attachments/8951/2007-103-4_20071034.pdf.
- Lichtenstein, Paul, Linda Halldner, Johan Zetterqvist, Arvid Sjölander, Eva Serlachius, Seena Fazel, Niklas Långström, and Henrik Larsson. 2012. Medication for attention deficit-hyperactivity disorder and criminality. New England Journal of Medicine 367(21): 2006–2014. doi: 10.1056/NEJMoa1203241.CrossRefGoogle Scholar
- Marmot, M.G. 2005. The status syndrome: how social standing affects our health and longevity. New York: Henry Holt.Google Scholar
- OECD. 2013. What future for health spending?. No. 19. OECD Economics Department Policy Notes. http://www.oecd.org/eco/growth/aaaaaawhatfuture.pdf.
- Rachels, James. 2001. Theory and practice. In Encyclopedia of ethics, ed. Lawrence Becker and Charlotte Becker, 2nd edn. vol. 3, 1706–1708. New York: Routledge.Google Scholar
- Reznek, Lawrie. 1987. The nature of disease. London: Routledge & Kegan Paul.Google Scholar
- Sandel, Michael J. 2007. The case against perfection: ethics in the age of genetic engineering. Cambridge: Belknap Press of Harvard University Press.Google Scholar
- Scheffler, Richard M., Timothy T. Brown, Brent D. Fulton, Stephen P. Hinshaw, Peter Levine, and Susan Stone. 2009. Positive association between attention-deficit/hyperactivity disorder medication use and academic achievement during elementary school. Pediatrics 123(5): 1273–1279. doi: 10.1542/peds.2008-1597.CrossRefGoogle Scholar
- Wang, D., M. Connock, P. Barton, A. Fry-Smith, P. Aveyard, and D. Moore. 2008. ‘Cut down to quit’ with nicotine replacement therapies in smoking cessation: a systematic review of effectiveness and economic analysis. Health Technology Assessment (Winchester, England) 12(2): iii–iv, ix–xi, 1–135.Google Scholar
- Wang, Haidong, Laura Dwyer-Lindgren, Katherine T. Lofgren, Julie Knoll Rajaratnam, Jacob R. Marcus, Alison Levin-Rector, Carly E. Levitz, Alan D. Lopez, and Christopher J.L. Murray. 2012. Age-specific and sex-specific mortality in 187 countries, 1970–2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet 380(9859): 2071–2094. doi: 10.1016/S0140-6736(12)61719-X.CrossRefGoogle Scholar