Inconsistency in moral judgements

Abstract

Suppose one can fully alleviate either the very large individual health burdens of a first group or instead the significantly lesser burdens of a second group that is at least as numerous. In such cases, the most commonly applied principles for priority setting in health have two characteristics – prioritization by severity and unlimited aggregation. First, when both groups are equally large, they prioritize the more severely burdened. Second, when both groups differ in size, these common principles are unlimited in their aggregation: one very large burden can be outweighed not merely by a large number of middling burdens, but also by a sufficiently large number of very minor burdens. While priority for the significantly more severely burdened when group sizes are equal is uncontroversial, many thinkers have challenged unlimited aggregation. There is, however, little evidence on the public’s views. Here, we examine the responses to priority-setting dilemmas (rationing decisions) of a representative sample of the UK population (n = 389). An overwhelming majority of respondents’ views do not align with commonly used priority setting principles. A substantial share (forty-four per cent) of respondents does not always prioritize by severity when group sizes are equal. Moreover, among those who do prioritize by severity, most reject unlimited aggregation. A test for the influence of the assumed status quo did not yield a robust effect. We discuss why such caseprinciple inconsistency – when people’s rationing decisions in concrete cases depart from established priority setting principles – might be problematic to policy makers and we offer potential normative justifications for some of the observed departures. Overall, our findings suggest that public support for commonly employed priority-setting principles cannot be assumed, and that unorthodox principles that place limits on the ability of very small burdens to outweigh very large ones may be more popular. To inform the development of prioritization principles that might better reflect people’s moral values, we highlight the need for further empirical research on the views of the public that would deepen our understanding of what drives their views and of how consistent these are across cases that require similar moral trade-offs (case-case inconsistency).