Priority preferences: "end of life" does not matter, but total life does

Value Health. 2013 Sep-Oct;16(6):1063-6. doi: 10.1016/j.jval.2013.06.002. Epub 2013 Jul 18.


There is increasing evidence that the social value of an incremental health gain depends on patient characteristics, such as their age and their prognosis. This article presents an analytical framework to illustrate how a disease splits our life expectancy into 1) past health (age), 2) prognosis untreated, 3) gain from treatment, and 4) incurable loss. A Norwegian population sample was asked to make pairwise choices and prioritize hypothetical patients who differed in terms of age (30, 50, and 70 years old), remaining lifetime without treatment (1, 3, and 10 years), and increase in remaining lifetime with treatment (1 month, 3 months, 1 year, and 3 years). Their preferences reveal strong support for the "fair innings" argument that total lifetime inequalities should be reduced. Differences in patients' remaining lifetime without treatment did not matter, implying little support for the "end-of-life" argument that a short life expectancy makes patients entitled to preferential treatment.

Keywords: priority preferences; “end of life”; “fair innings.”.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Choice Behavior
  • Female
  • Humans
  • Life Expectancy*
  • Male
  • Middle Aged
  • Norway
  • Patient Preference*
  • Quality of Life*
  • Social Values
  • Terminal Care*
  • Young Adult