Disease prioritarianism: a flawed principle

Abstract

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’.

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Notes

  1. 1.

    The term ‘medicalization’, first coined by social critics, describes the social process by which a human condition comes to be seen as a medical problem.

  2. 2.

    In this context ‘effective’ refers to the power of an intervention to produce a desired effect. By contrast, ‘efficient’ means ‘cost-effective’ in this context.

  3. 3.

    I am thankful to an anonymous reviewer for this comment.

  4. 4.

    This observation is valid notwithstanding normative theory. If, for example, retributivists believe that the criminal system ought to punish criminals rather than prevent reoffending, this punishment could be administered by medical means. This is, in fact, the case in some states in the US where lethal injection is used to execute people.

  5. 5.

    However, it is worth pointing out that this intervention is very efficient in terms of QALY (see Henteleff et al. 2013).

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Correspondence to Karim Jebari.

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Jebari, K. Disease prioritarianism: a flawed principle. Med Health Care and Philos 19, 95–101 (2016). https://doi.org/10.1007/s11019-015-9649-2

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Keywords

  • Medical ethics
  • Medicalization
  • Disease
  • Prioritization
  • Cost-benefit analysis