# Cost-Effectiveness and the Distinction Between Quantitative and Qualitative Disability Discrimination

## TL;DR

This paper explores when it is justifiable to discriminate against people with disabilities in healthcare resource allocation based on lifespan versus quality of life.

## Contribution

The paper introduces the Reasonable Impartial Interest Argument to defend the asymmetry intuition in disability discrimination.

## Key findings

- Discrimination based on lifespan is more justifiable than based on quality of life.
- The asymmetry intuition is better supported by the Reasonable Impartial Interest Argument.
- This contributes to fairer cost-effective healthcare resource allocation.

## Abstract

Since standard measures of health effect ascribe negative value to disabilities, it is commonly believed that a cost-effective scheme for allocation of healthcare resources discriminates against people with disabilities. It is still a question for discussion, however, when and why such discrimination is justified. In this paper I account for the central normative substance of this disability discrimination problem, and I defend the claim that it is more justifiable to discriminate against disabled people based on lifespan considerations than on assessments of their reduced quality of life. I term this the asymmetry intuition. Based on some prior attempts to explain the asymmetry intuition, I offer the Reasonable Impartial Interest Argument as the best possible way to defend it. If my argument is sound, this moves us a step further towards a cost-effective priority setting that does not unjustly discriminate against people with disabilities.