Setting Health-Care Priorities: What Ethical Theories Tell Us, Torbjörn Tännsjö,. Oxford University Press, 2019, xii + 212 pages.

Setting Health-Care Priorities: What Ethical Theories Tell Us, Torbjörn Tännsjö. Oxford University Press, 2019, xii + 212 pages.

The issue of how to set health-care priorities fairly (or justly, or ethically) is one of the most pressing normative issues of our time. Many health-care resources are scarce, and we need some way of systematically assessing different prioritizations. There is also a growing and already very rich literature that addresses the topic, from different perspectives and with contributions from a variety of disciplines. Health economists have for decades worked on outlining summary measures of health that can be used to evaluate distributions of health-related resources and decision tools that can help guide practical priority-setting decisions such as decisions about which treatments to include in insurance plans (e.g. Nord 1999; Cookson 2015). Philosophers have developed normative theories designed specifically for the topic (e.g. Daniels 2008; Fleck 2009; Segall 2010). Several research groups have also explored approaches that combine philosophy with empirical studies, presenting normative principles that are grounded both in philosophy and in public opinion (e.g. Petrou et al.2013; Ottersen et al.2014). In Setting Health-Care Priorities: What Ethical Theories Tell Us, Torbjörn Tännsjö sets out to explore what ethical theories can tell us about the issue without engaging much with the existing literature.

The book has two main parts. In the first part, Tännsjö claims that there are only three ethical theories that can be relevant to priority-setting, outlines these theories and presents his own view of how plausible each theory is (without claiming that the reader should necessarily agree with him). In the second part, he attempts to apply the theories to priority-setting problems in real life. What I take to be the main argument of the book is that the ethical theories converge when they are applied to practical priority-setting problems, and they all recommend fairly radical re-thinking of health-care policy. More precisely, Tännsjö argues that at a highly general level the most plausible ethical theories all say that, at least in the industrialized world, resources should be diverted from end-of-life care to other more impactful kinds of health-care interventions. Whereas I am quite sympathetic to this proposal, and in particular to the view that treatment of mental illnesses has been largely...