The ethics of aggregation and hormone replacement therapy.

Journal Article (Journal Article)

The use of aggregated quality of life estimates in the formation of public policy and practice guidelines raises concerns about the moral relevance of variability in values in preferences for health care. This variability may reflect unique and deeply held beliefs that may be lost when averaged with the preferences of other individuals. Feminist moral theories which argue for attention to context and particularity underline the importance of ascertaining the extent to which differences in preferences for health states reveal information which is morally relevant to clinicians and policymakers. To facilitate these considerations, we present an empirical study of preferences for the timing and occurrence of health states associated with hormone replacement therapy (HRT). Sixteen women between the ages of 45 and 55 were enrolled in this pilot study. Their preferences regarding five health states associated with HRT (menopausal symptoms. side effects of HRT, breast cancer, myocardial infarction, and osteoporosis) were assessed in quantitative terms known as utilities. Two standard methods, the visual analog scale (VAS) and the standard gamble (SG), were used to assess utility and time preference (calculated as a discount rate). The wide variability of responses underlines the importance of tailoring health care to individual women's preferences. Policy guidelines which incorporate utility analysis must recognize the normative limitations of aggregated preferences, and the moral relevance of individual conceptions of health.

Full Text

Duke Authors

Cited Authors

  • Lyerly, AD; Myers, ER; Faden, RR

Published Date

  • 2001

Published In

Volume / Issue

  • 9 / 2

Start / End Page

  • 187 - 211

PubMed ID

  • 11561996

International Standard Serial Number (ISSN)

  • 1065-3058

Digital Object Identifier (DOI)

  • 10.1023/A:1011386320609


  • eng

Conference Location

  • Netherlands