title: The ethics of aggregation and hormone replacement therapy.
abstract: The use of aggregated quality of life estimates in the formation of public policy and practice guidelines raises concerns about the moral relevance of variability in values in preferences for health care. This variability may reflect unique and deeply held beliefs that may be lost when averaged with the preferences of other individuals. Feminist moral theories which argue for attention to context and particularity underline the importance of ascertaining the extent to which differences in preferences for health states reveal information which is morally relevant to clinicians and policymakers. To facilitate these considerations, we present an empirical study of preferences for the timing and occurrence of health states associated with hormone replacement therapy (HRT). Sixteen women between the ages of 45 and 55 were enrolled in this pilot study. Their preferences regarding five health states associated with HRT (menopausal symptoms. side effects of HRT, breast cancer, myocardial infarction, and osteoporosis) were assessed in quantitative terms known as utilities. Two standard methods, the visual analog scale (VAS) and the standard gamble (SG), were used to assess utility and time preference (calculated as a discount rate). The wide variability of responses underlines the importance of tailoring health care to individual women's preferences. Policy guidelines which incorporate utility analysis must recognize the normative limitations of aggregated preferences, and the moral relevance of individual conceptions of health.
authors.affiliation: The Bioethics Institute, Johns Hopkins University, Baltimore, MD 21205, USA. alyerly@jhsph.edu
authors.forename: A D
authors.initials: AD
authors.lastname: Lyerly
authors.forename: E R
authors.initials: ER
authors.lastname: Myers
authors.forename: R R
authors.initials: RR
authors.lastname: Faden
mesh_terms: D003362:Cost-Benefit Analysis; D003657:Decision Making; D015914:Estrogen Replacement Therapy / Q000592:standards*; D004992:Ethics, Medical; D005260:Female; D019513:Feminism; D006801:Humans; D008593:Menopause; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010865:Pilot Projects; D014481:United States