DECISION-MAKING PROCESS
The health capability paradigm combines the evidence-base of health care and public health with input from individuals, physicians and public experts to assess the value of treatments, medications and other policies in terms of their own experiences. This methodology examines the necessity and appropriateness of medical care using both individual and collective choice, building policies that value human flourishing and health capabilities.
Using a joint scientific and deliberative process, the health capability paradigm prioritizes reasoned consensus on allocating resources. This theoretical framework balances a consequentialist focus on health outcomes and costs with a proceduralist respect for individuals’ health agency.
Consequentialism suggests an action is good or bad depending on its outcome, whereas proceduralism believes in instituting and following a valid process. For example, allocation decisions amid COVID-19 should maximize human good and minimize harm. At the same time, they should be determined by a process that universally values human flourishing and health capabilities.
This follows a collaborative and participatory approach, where individuals have primary authority for health care decisions while experts evaluate outcomes using their medical knowledge and expertise. Health interventions and allocation decisions should come from a stepwise process that reviews scientific evidence about the consequences of policies on health. Recommendations should be updated frequently to account for changes in medical knowledge, technology and costs, and ethical rules should adapt to new circumstances.
