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189:oral Severity and illness Adaptation
  1. Borgar Jølstad
  1. Avdeling for Helsetjenesteforskning (HØKH); Akershus Universitetssykehus; Norway


Adaptation to illness, and its relationship with priority setting in health, is a vexing and morally important issue. According to conventional quality-of-life measures and health state valuations, people with various illnesses are not as badly off as others may imagine. This is partly due to adaptation: the process of adjusting to changed circumstances. When we prioritize in accordance with consequentialism, it matters a great deal to get measures of who is worse off right. Whether or not to account for adaptation when deciding who is worse off, and consequentially should be prioritized, has been extensively debated. Arguments against highlight that people sometimes adapt to conditions they should not have to adapt to. This is in line with Amartya Sen’s argument against relying on subjective indicators of well-being; people in poverty adapt to their condition, and this will tend to mask injustice if subjective indicators are relied on to the exclusion of objective factors. In our paper, we wish to argue that illnesses that one does not adapt to are, all else equal, more severe than illnesses that one does adapt to. We assume that severity is, at least partly, a measure of health-related worse off-ness. The first part of the argument is that if adaptation is successful, then there is less suffering. Not adapting means more suffering and is, therefore, all else equal, worse than not adapting. Disregarding the relative lack of suffering of those who adapt also means disregarding the suffering of those who do not adapt. We then argue that no plausible theory of well-being relevant for health care can disregard the importance of suffering. Lastly, we argue that not considering adaptation leads to a relative lack of priority for illnesses that are difficult or impossible to adapt to, such as depression.

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