14. Ethical Issues in Resource Allocation, Research, and New Product Development

Abstract

Ethical issues in health care policy exist in all societies, but they are more pronounced in developing countries where needs are great and resources few. Some ethical controversies have become obstacles to badly needed health research.

Resource allocation generally must satisfy two criteria: cost–effectiveness and equity. Sometimes efficiency and equity coincide; but in many cases there are moral reasons for an allocation that is not cost–effective. For example, the standard assumption in cost–effective analysis is that a quality–adjusted life year (QALY) has the same social value, regardless of a beneficiary's age, but questions have arisen over whether a QALY should be valued differently for older versus younger people. Similarly, while most people agree that those potential beneficiaries who are suffering the most should receive priority attention, questions arise over how much priority to give to one group at the expense of others, especially if little improvement is expected. In health research, international standards require that the new methods or drugs tested on humans be evaluated against the best current method. But some have asked whether this standard is useful in cases where less–than–best methods could offer significant benefits to a poor country.

One approach to resolving ethical issues in poor countries would be to focus on building internal capacity for ethical review, placing the locus of decision making closer to the people who are most affected.