Methods in Medical Ethics

By Jeremy Sugarman; Daniel P. Sulmasy | Go to book overview

13
Economics and Decision Science

David A. Asch

1 doubt that many health economists or medical decision scientists believe they are making contributions to the fields of medical ethics in the course of their everyday work. The methods used by scholars in these fields are attractive in part because they appear highly quantitative and value free. Those characteristics might make these approaches seem out of place within a list of tools to address problems in ethics, since ethical problems are so often seen as conflicts of value. Some economists and decision scientists probably take refuge in the view that their methods are ostensibly silent on the issue of values. But even if these fields really are value free at the level of their methodology, their contribution to the manipulation and analysis of values provided from other sources still offers much to empirical work in medical ethics. However, at a very fundamental level, these fields take an implicit value-laden stance—one based largely on some form of utilitarianism. Sometimes that stance is obscured by the methodology that overlies it, but understanding what values may lurk underneath these seemingly sterile approaches will help scholars and policy makers understand both the potentially profound applications and the limitations of these methods.

In this chapter, I focus on certain popular and normatively appealing techniques, such as decision analysis, broadly; cost-effectiveness analysis; and related forms of clinical economics, more specifically. However, there is much more to decision sciences than just decision analysis. For example, decision analysis is a technique for choosing among alternatives in the face of uncertainty. It is a normative approach. But many who consider themselves decision scientists focus on descriptive observational or experimental studies of decision processes in an attempt to understand how clinicians and patients actually make medical decisions, to uncover biases in those processes (against some normative standard), and, more prescriptively, to de-bias, or in other ways improve them.

Similarly, there is much more to health economics than cost-effectiveness analysis or cost-benefit analysis. Health economists also address the social and clinical implications of changes in health care financing, such as the introduction of new insurance products or modifications in the incentive structure for health systems or clinicians. Similarly, they may study the implication of changes in clinician labor force (size, specialty, or geographic distribution) or related changes in projected patient demand, given changing demographics or

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Methods in Medical Ethics
Table of contents

Table of contents

  • Title Page i
  • Contents v
  • Preface vii
  • Acknowledgments xi
  • Contributors xiii
  • Part I - Overview 1
  • 1: The Many Methods of Medical Ethics (Or, Thirteen Ways of Looking at a Blackbird) 3
  • 2: A Decade of Empirical Research in Medical Ethics 19
  • Part II - Methods 29
  • 3: Philosophy 31
  • 4: Religion and Theology 47
  • 5: Professional Codes 70
  • 6: Legal Methods 88
  • 7: Casuistry 104
  • 8: History 126
  • 9: Qualitative Methods 146
  • 10: Ethnographic Methods 169
  • 11: Quantitative Surveys 1 192
  • 12: Experimental Methods 207
  • 13: Economics and Decision Science 227
  • Part III - Relationships and Applications 245
  • 14: Research in Medical Ethics: Physician-Assisted Suicide and Euthanasia 247
  • 15: Research in Medical Ethics: Genetic Diagnosis 1 267
  • 16: Reading the Medical Ethics Literature: a Discourse on Method 286
  • Index 298
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