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

Publication ,  Journal Article
Volk, ML; Lok, ASF; Ubel, PA; Vijan, S
Published in: Medical decision making : an international journal of the Society for Medical Decision Making
September 2008

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).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.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.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.

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Published In

Medical decision making : an international journal of the Society for Medical Decision Making

DOI

EISSN

1552-681X

ISSN

0272-989X

Publication Date

September 2008

Volume

28

Issue

5

Start / End Page

763 / 772

Related Subject Headings

  • Waiting Lists
  • Tissue and Organ Procurement
  • Survival Analysis
  • Markov Chains
  • Liver Transplantation
  • Humans
  • Health Policy & Services
  • Decision Support Techniques
  • Acute Disease
  • 4206 Public health
 

Citation

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Volk, M. L., Lok, A. S. F., Ubel, P. A., & Vijan, S. (2008). Beyond utilitarianism: a method for analyzing competing ethical principles in a decision analysis of liver transplantation. Medical Decision Making : An International Journal of the Society for Medical Decision Making, 28(5), 763–772. https://doi.org/10.1177/0272989x08316999
Volk, Michael L., Anna S. F. Lok, Peter A. Ubel, and Sandeep Vijan. “Beyond utilitarianism: a method for analyzing competing ethical principles in a decision analysis of liver transplantation.Medical Decision Making : An International Journal of the Society for Medical Decision Making 28, no. 5 (September 2008): 763–72. https://doi.org/10.1177/0272989x08316999.
Volk ML, Lok ASF, Ubel PA, Vijan S. Beyond utilitarianism: a method for analyzing competing ethical principles in a decision analysis of liver transplantation. Medical decision making : an international journal of the Society for Medical Decision Making. 2008 Sep;28(5):763–72.
Volk, Michael L., et al. “Beyond utilitarianism: a method for analyzing competing ethical principles in a decision analysis of liver transplantation.Medical Decision Making : An International Journal of the Society for Medical Decision Making, vol. 28, no. 5, Sept. 2008, pp. 763–72. Epmc, doi:10.1177/0272989x08316999.
Volk ML, Lok ASF, Ubel PA, Vijan S. Beyond utilitarianism: a method for analyzing competing ethical principles in a decision analysis of liver transplantation. Medical decision making : an international journal of the Society for Medical Decision Making. 2008 Sep;28(5):763–772.
Journal cover image

Published In

Medical decision making : an international journal of the Society for Medical Decision Making

DOI

EISSN

1552-681X

ISSN

0272-989X

Publication Date

September 2008

Volume

28

Issue

5

Start / End Page

763 / 772

Related Subject Headings

  • Waiting Lists
  • Tissue and Organ Procurement
  • Survival Analysis
  • Markov Chains
  • Liver Transplantation
  • Humans
  • Health Policy & Services
  • Decision Support Techniques
  • Acute Disease
  • 4206 Public health