Rethinking patient involvement in healthcare priority setting

2020. Lars Sandman, Bjorn Hofmann, Greg Bognar. Bioethics 34 (4), 403-411

Article

With healthcare systems under pressure from scarcity of resources and ever-increasing demand for services, difficult priority setting choices need to be made. At the same time, increased attention to patient involvement in a wide range of settings has given rise to the idea that those who are eventually affected by priority setting decisions should have a say in those decisions. In this paper, we investigate arguments for the inclusion of patient representatives in priority setting bodies at the policy level. We find that the standard justifications for patient representation, such as to achieve patient-relevant decisions, empowerment of patients, securing legitimacy of decisions, and the analogy with democracy, all fall short of supporting patient representation in this context. We conclude by briefly outlining an alternative proposal for patient participation that involves patient consultants.

The Mismarriage of Personal Responsibility and Health

2020. Greg Bognar. Cambridge Quarterly of Healthcare Ethics 29 (2), 196-204

Article

This paper begins with a simple illustration of the choice between individual and population strategies in population health policy. It describes the traditional approach on which the choice is to be made on the relative merits of the two strategies in each case. It continues by identifying two factors-our knowledge of the consequences of the epidemiological transition and the prevalence of responsibility-sensitive theories of distributive justice-that may distort our moral intuitions when we deliberate about the choice of appropriate risk-management strategies in population health. It argues that the confluence of these two factors may lead us to place too much emphasis on personal responsibility in health policy.

The value of longevity

2020. Greg Bognar. Politics, Philosophy and Economics 19 (3), 229-247

Article

Longevity is valuable. Most of us would agree that it's bad to die when you could go on living, and death's badness has to do with the value your life would have if it continued. Most of us would also agree that it's bad if life expectancy in a country is low, it's bad if there is high infant mortality and it's bad if there is a wide mortality gap between different groups in a population. But how can we make such judgments more precise? How should we evaluate the harm of mortality in a population? Although philosophers have written a lot about the harm of death for individuals, very little work has been done on the harm of mortality for populations. In this article, I take the first steps towards developing a theory of the harm of population mortality. Even these first steps, I argue, lead to surprising results.

CATERING FOR RESPONSIBILITY

2019. Greg Bognar. Economics and Philosophy 35 (2), 259-281

Article

The distinction between brute luck and option luck is fundamental for luck egalitarianism. Many luck egalitarians write as if it could be used to specify which outcomes people should be held responsible for. In this paper, I argue that the distinction can't be used this way. In fact, luck egalitarians tend to rely instead on rough intuitive judgements about individual responsibility. This makes their view vulnerable to what's known as the neutrality objection. I show that attempts to avoid this objection are unsuccessful. I conclude that until it provides a better account of attributing responsibility, luck egalitarianism remains incomplete.

Overpopulation and Procreative Liberty

2019. Greg Bognar. Ethics, Policy & Environment 22 (3), 319-330

Article

A few decades ago, there was a lively debate on the problem of overpopulation. Various proposals to limit population growth and to control fertility were made and debated both in academia and in the public sphere. In the intervening decades, however, the idea of limiting population growth became taboo in policy discussions and was completely ignored in philosophy. More recently, there has been a small revival of anti-natalism in population policy and social philosophy. This is in part due to the growing recognition that the demographic transition might not be completed all around the world before overpopulation causes irreversible social, political, or environmental harm. Several proposals have been made to limit family size and lower fertility. However, all of these proposals are based on incentives only, and all are strictly voluntary: in their discussion, involuntary fertility control is considered coercive and therefore thought to necessarily involve a gross violation of procreative liberty and personal autonomy. The aim of this paper is to demonstrate that anti-natalist population policies need not involve the violation of procreative liberty and personal autonomy. To show this, I revive two radical proposals from the old debate. The first involves mandatory long-term contraception; the second involves the introduction of tradeable procreation entitlements. I show that contrary to what many people believe, these policies can be defended on the basis of broadly liberal principles. Not only do they not conflict with procreative liberty and personal autonomy, but they can actually increase liberty and promote autonomy.

Fairness and the Puzzle of Disability

2018. Greg Bognar. Theoria 84 (4), 337-355

Article

Consider two cases. In Case 1, you must decide whether you save the life of a disabled person or you save the life of a person with no disability. In Case 2, you must decide whether you save the life of a disabled person who would remain disabled, or you save the life of another disabled person who, in contrast, would also be cured as a result of your intervention. It seems that most people agree that you should give equal chances in Case 1: saving the life of the person with no disability would be unfair discrimination against the person with disability. Yet, in Case 2, it appears that many people believe that you are at least permitted to save straightaway the person who would have no disability after your intervention. There would be no unfair discrimination against the other person. I argue that these judgements present a puzzle for theories of resource allocation in normative ethics. The puzzle is straightforward for consequentialists: the two cases have the same outcomes, but the judgements are different. But the puzzle also presents a problem for nonconsequentialist views. After introducing the cases, I show this by reviewing a number of proposals for solving the puzzle. I argue that none of these proposals are successful. I then make my own proposal and conclude by spelling out its implications.

Scarcity

2018. Greg Bognar. International Encyclopedia of Ethics

Chapter

It is often said that economics is the science of scarcity. But since a lot of economics is just applied ethics, it is perhaps more apt to say the real science of scarcity is ethics. Scarcity is arguably one of the fundamental problems that morality has evolved to address, and most discussions in ethics assume some kind of scarcity in the background. I show this by considering a number of issues in ethics, from resource allocation to self‐control, where scarcity plays a major role.

Is disability mere difference?

2016. Greg Bognar. Journal of Medical Ethics 42 (1), 46-49

Article

Priority Setting and Age

2016. Greg Bognar. Prioritization in Medicine, 163-177

Chapter

The role of age in priority setting is one of the most controversial issues in health policy. It has also been a contentious topic for many years in medical ethics and philosophy, and any discussion of age as a criterion for setting priorities in health care is likely to stir up intense public debate. Age is an easily observable characteristic; hence it is tempting to use it when priorities must be set between different resource uses or patient groups. Indeed, age considerations pervade health systems worldwide. Consequently, there is an urgent need to clarify the role that age can play in health care resource allocation.

Fair Innings

2015. Greg Bognar. Bioethics 29 (4), 251-261

Article

In many societies, the aging of the population is becoming a major problem. This raises difficult issues for ethics and public policy. On what is known as the fair innings view, it is not impermissible to give lower priority to policies that primarily benefit the elderly. Philosophers have tried to justify this view on various grounds. In this article, I look at a consequentialist, a fairness-based, and a contractarian justification. I argue that all of them have implausible implications and fail to correspond to our moral intuitions. I end by outlining a different kind of consequentialist justification that avoids those implications and corresponds better to our considered moral judgments.

QALYs, DALYs, and Their Critics

2015. Greg Bognar. The Routledge Companion to Bioethics, 44-55

Chapter

Greg BognarProfessor

About me

Research projects

Publications

Rethinking patient involvement in healthcare priority setting

The Mismarriage of Personal Responsibility and Health

The value of longevity

CATERING FOR RESPONSIBILITY

Overpopulation and Procreative Liberty

Fairness and the Puzzle of Disability

Scarcity

Is disability mere difference?

Priority Setting and Age

Fair Innings

QALYs, DALYs, and Their Critics