resource allocation

Podcast: Genetic Parenthood, Assisted Reproduction, and the Values of Parental Love

On the evening of Thursday 28 December, Prof. Justin Oakley, Deputy Director of the Centre for Human Bioethics at Monash University, gave a fascinating and suggestive lecture on whether there is reason for the state to broaden access to IVF treatment for childless people as well as facilitating adoption. Continue reading

Oxford Martin School Seminar: Robert Rogers and Paul Van Lange on Social Dilemmas

In a joint event on November 15th, Prof Robert Rogers and Prof Paul van Lange presented their scientific work related to social dilemmas.

Social dilemmas are situations in which private interests conflict with collective interests. This means that people facing a social dilemma have to decide whether to prioritise either their own short-term interests or the long-term interests of a group. Many real-life situations are social dilemmas. For example, as individuals we would (economically) benefit from using public motorways without paying taxes to maintain them, but if all acted according to their self-interest, no motorways would be built and the whole society would be worse off. In the academic literature, the three types of social dilemmas that are discussed most prominently are the Prisoner’s Dilemma, the Public Goods Dilemma, and the Tragedy of the Commons. All three types have been modelled as experimental games, and research from different fields like psychology, neuroscience, and behavioural economics uses these games to tackle the question of under which conditions people are willing to cooperate with one another in social dilemmas, instead of maximising their self-interest. The ultimate goal of such research is to be able to give recommendations about how to solve social dilemmas in society.

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Nudge Drugs: should the social side-effects of medications weigh into public health?

You are a public health official responsible for the purchasing of medications for the hospitals within your catchment area in the NHS. Your policies significantly affect which, out of the serpentine lists of heart disease medications, for example, are available to your patients. Today, you must choose between purchasing one of three heart disease medications: Drug A, Drug B, and Drug C. They are pretty similar in efficacy, and all three have been being used for many years. Drug B is slightly less expensive than Drug A and Drug C, but there is emerging evidence that it increases the likelihood that patients will take “bad bets,” i.e. make large gambles when the chance of winning is low (and thus might contribute to large social costs). Drug C costs a tiny bit more than Drug A, but there is some evidence that Drug C may help decrease implicit racial bias. You have been briefed on the research suggesting that implicit racial bias can lead to people making choices that consistently and unintentionally limit the opportunities of certain groups, even when all the involved parties show explicit commitments to social equality.  Finally, there is emerging evidence that drug A both helps people abstain from alcohol and dissociates negative emotional content from memories.

Which drug should you purchase?

 

Let us begin to think about this question through the lens of the idea of the “Nudge,” which has exploded onto the public sphere (and blogosphere) since Thaler and Sunstein’s published their book, “Nudge: improving decisions about health, wealth, and happiness.”   (see the blog here). I briefly and incompletely introduce nudges here, in hopes that we may soon move on to discuss the kind of “nudge drugs” our thought experiment considers.

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The cost of living and the cost of dying

X, a patient with reliably diagnosed PVS, lies in a hospital bed for years, fed via a nasogastric tube. He has not, and by definition never will have, any capacity for pain, pleasure or any sort of sensation. Devoted family members come each day to sit by his bedside, but he has no idea that they are devoted, or that they exist.
It is expensive to keep him alive. He occupies a bed and consumes a good deal of nursing time.
The NHS Trust responsible for his care has a limited budget. It decides that the money spent on maintaining his merely biological life would be better spent on dialysis machines. It can, and does, justify its decision in purely utilitarian terms. It writes in the minutes of the relevant committee meeting: ‘For the money we spend keeping X alive, we can save the lives of 10 kidney patients, each of whom will have a good quality of life for many years. The QALY arithmetic makes X’s continued existence nonsensical.’ Continue reading

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