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Affordability and Non-Perfectionism in Moral Action.

Benedict RumboldVictoria CharltonAnnette RidPolly MitchellJames WilsonPeter LittlejohnsCatherine MaxAlbert Weale
Published in: Ethical theory and moral practice : an international forum (2019)
One rationale policy-makers sometimes give for declining to fund a service or intervention is on the grounds that it would be 'unaffordable', which is to say, that the total cost of providing the service or intervention for all eligible recipients would exceed the budget limit. But does the mere fact that a service or intervention is unaffordable present a reason not to fund it? Thus far, the philosophical literature has remained largely silent on this issue. However, in this article, we consider this kind of thinking in depth. Albeit with certain important caveats, we argue that the use of affordability criteria in matters of public financing commits what Parfit might have called a 'mistake in moral mathematics'. First, it fails to abide by what we term a principle of 'non-perfectionism' in moral action: the mere fact that it is practically impossible for you to do all the good that you have reason to do does not present a reason not to do whatever good you can do. And second, when used as a means of arbitrating between which services to fund, affordability criteria can lead to a kind of 'numerical discrimination'. Various attendant issues around fairness and lotteries are also discussed.
Keyphrases
  • mental health
  • healthcare
  • randomized controlled trial
  • health insurance
  • systematic review
  • decision making
  • preterm infants
  • clinical trial
  • public health
  • affordable care act
  • electronic health record
  • adverse drug