Table 1 Overview of frameworks for preference elicitation
Normative framework | Ethical neutrality | Maximizing preference satisfaction | Maximizing substantive value | Meeting principles consented to | |||
|---|---|---|---|---|---|---|---|
Ethical orientation | Ethically neutral / behaviorist position | Preference utilitarianism | Health-related consequentialism | Utilitarianism | Capability- oriented consequentialism | Contract ethics / Nonaggregationism | |
Economic theory | Neoclassical axiomatic utility theory | Health-related extra-welfarism | Hedonistic utility theory | Capability-related extra-welfarism | Constitutional economics | ||
Concept of preference | Ethically neutral predictor of choice | Undisputable desire/taste | “Laundered”/ “rational” desire | Evaluation of health state | Evidence of happiness | Evidence of capabilities | Fairness judgment regarding priorities |
Aim of preference elicitation | No elicitation of “preferences” but prediction of choice | Measure strength of preference satisfaction (potentially including ethical preferences) | Parameterize health-related quality-of life measure | Provide evidence of happiness | Parameterize capability measure | Consistency checks of multi-attributive concepts of value | |
Concept of social value | N.A. (predict market share) | Aggregated preference satisfaction | Aggregated sum of (weighted) health outcomes | Aggregated sum of happiness | Aggregated sum of achieved capabilities | Consistent decisions according to rules consented to | |
Challenge (example) | No normative guidance for social decision | Doubtful that gut feeling leads to consistent, rational rank orders | Difficult to determine “laundered” and to justify “strength of preference” | Ambiguity of health measures | (Neoclassical) concerns against hedonistic utilitarianism | Concerns against consequentialism, lack of operationalization | Lack of substantive evaluation criteria, difficult to establish consent |