Beyond utilitarianism: a method for analyzing competing ethical principles in a decision analysis of liver transplantation.

Published

Journal Article

BACKGROUND: The utilitarian foundation of decision analysis limits its usefulness for many social policy decisions. In this study, the authors examine a method to incorporate competing ethical principles in a decision analysis of liver transplantation for a patient with acute liver failure (ALF). METHODS: A Markov model was constructed to compare the benefit of transplantation for a patient with ALF versus the harm caused to other patients on the waiting list and to determine the lowest acceptable 5-y posttransplant survival for the ALF patient. The weighting of the ALF patient and other patients was then adjusted using a multiattribute variable incorporating utilitarianism, urgency, and other principles such as fair chances. RESULTS: In the base-case analysis, the strategy of transplanting the ALF patient resulted in a 0.8% increase in the risk of death and a utility loss of 7.8 quality-adjusted days of life for each of the other patients on the waiting list. These harms cumulatively outweighed the benefit of transplantation for an ALF patient having a posttransplant survival of less than 48% at 5 y. However, the threshold for an acceptable posttransplant survival for the ALF patient ranged from 25% to 56% at 5 y, depending on the ethical principles involved. DISCUSSION: The results of the decision analysis vary depending on the ethical perspective. This study demonstrates how competing ethical principles can be numerically incorporated in a decision analysis.

Full Text

Duke Authors

Cited Authors

  • Volk, ML; Lok, ASF; Ubel, PA; Vijan, S

Published Date

  • September 2008

Published In

Volume / Issue

  • 28 / 5

Start / End Page

  • 763 - 772

PubMed ID

  • 18725405

Pubmed Central ID

  • 18725405

Electronic International Standard Serial Number (EISSN)

  • 1552-681X

International Standard Serial Number (ISSN)

  • 0272-989X

Digital Object Identifier (DOI)

  • 10.1177/0272989x08316999

Language

  • eng