Choice Group

When the number of people one can save from harm is fixed, and the difference in harm one can save people from is substantial, standard principles for health resource allocation prioritize by severity. For example, if death is a substantially greater harm than paraplegia, then saving one from death takes priority over saving a different person from paraplegia. Standard principles are also fully aggregative: one death can be outweighed not merely by a large number of cases of paraplegia, but also by a sufficiently large number of very minor burdens (such as a case of toenail fungus). While prioritization by severity in fixed-number cases involving substantially different harms is uncontroversial among leading thinkers, many have challenged full aggregation. Instead, they have proposed a limited form of aggregation, on which a large number of cases of paraplegia can outweigh one death, but no number of cases of toenail fungus can outweigh one death. One reason cited in favour of limited aggregation is its supposed better fit with people’s considered moral judgments. There is, however, a lack of evidence on the public’s views. Here, we report the responses of a representative sample of the UK population to priority-setting dilemmas. We find that around half of respondents do not always adhere to prioritization by severity, primarily because of an apparent dislike for selecting one group facing death over another same-sized group in lesser, but still grave, need. However, among the remaining respondents, limited aggregation is much more popular than full aggregation. Our central results are robust to a test for status quo bias. They indicate that an overwhelming majority of people’s views do not align with standard priority setting principles, and that among those who prioritize by severity, limited aggregation is by far the most common.