Age Weighting and Discounting: What are the Ethical Issues?

The burden of disease is separable from the social value of that burden. In economic evaluation the social value of a program usually takes account of time preferences and future benefits are discounted. Recently, the WHO DALY has included weights to reflect the social importance of the burden of disease at different ages. It is argued here (1) that the most useful concept of the burden of disease may exclude age weights and time preference, (2) that the inclusion of age weights may, without care, result in double counting, (3) that the discounting of future health benefits does not, strictly, represent a technical requirement but is an ethical judgement a preference for a particular intertemporal distribution of health; (4) that decisions regarding such judgements should be informed by the judgements of the public and, further, the 'meta issue' of the appropriate use or dis-use of this preference data may itself be the subject of public choice. This is demonstrated using a survey of public preferences with respect to the desirability of governments implementing or overriding public preferences with respect to time preference. The term 'empirical ethics' is suggested to describe the empirical enquiry into ethical beliefs and the appropriate use of these empirical values.