[Economic efficiency and fairness: two ethical criteria? A basic reflection]

Many statements on the allocation of health care resources show an appreciation of the two criteria "efficiency" and "fairness" as two values which are to be weighed against each other in case of conflict. This article provides a critique of this model, which is conceived to rest on a hybrid (partly utilitarian, partly counter-utilitarian) basis. The most important fairness-related argument, or so it is argued, is of a sort which is incompatible with the reasons utilitarianism (or, indeed, consequentialism) provides as a basis for the efficiency criterion. If the argument is right, we have to provide another basis, at least as far as moral inhibitions are strong about taking efficiency into account. The present article does not go into detail about such an alternative. It relates to the on-going discussion on John Taurek's (1977) article about "numbers", especially on the so-called aggregation argument against Taurek's "no-worse-claim", and argues against the majority of commentators, consequentialist and deontological alike, that Taurek was right.