CARING FOR IDENTIFIED VERSUS STATISTICAL LIVES - AN EVOLUTIONARY VIEWOF MEDICAL DISTRIBUTIVE JUSTICE

A central medical ethical concern is distributive justice, which may b e framed as a problem in valuing identified lives versus statistical f ives, Framing the issue in this way is important for two reasons, Firs t, the growth of medical costs has been fueled and will continue to be fueled primarily by the growth of medical technology focused intensiv ely, and often with little benefit for cost, on the care of identified lives, Second, there is some evidence that less expensive primary car e, as opposed to high-tech medicine, is positively correlated with imp roved life expectancy, decreased infant and neonatal mortality, and fe wer cases of low birth weight, However, shifting resources from high-t ech medicine to primary care will be difficult because people find it psychologically painful to deny care to identified lives, People value identified lives more than statistical lives because we are influence d by certain cognitive preferences inherent to human nature, Natural s election has primed these cognitive preferences, There are no easy sol utions to the profound problems facing healthcare systems, However, ev olutionary insights can help us understand these-problems and could pr oductively inform attempts to promote primary care as opposed to high- tech medicine, thereby improving benefit for cost and enhancing social welfare. (C) Elsevier Science Inc., 1996.