Economics, Ethics, and End-of-Life Care

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Abstract
Pressure to reduce total health care expenditures in the United States has intensified. Despite a contracting health care budget that has sensitized society to the issues of resource allocation, the demand for the health care dollar has continued to expand. The disciplines of economics and bioethics have each outlined strategies to mitigate this conflict. Yet because of divergent core preferences, the proposed strategies are discordant. Whereas economics is chiefly concerned with the quantitative analysis of the production, distribution, and consumption of goods and services—an approach that often creates value-loaded trade-offs—bioethics often addresses the variance among competing values without accounting for resource scarcity.1 When the overall priority is to decrease monetary costs, selecting the most desirable way to allocate resources depends on which values are assumed to be paramount.2 If we are to develop morally acceptable principles for allocating scarce resources, the two approaches must reach a concordance.

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