The ethics of aggregation and hormone replacement therapy

Anne Drapkin Lyerly, Evan R. Myers, Ruth R. Faden

Research output: Contribution to journalReview articlepeer-review


The use of aggregated quality of life estimates in the formation of public policy and practice guidelines raises concerns about the moral relevance of variability in values in preferences for health care. This variability may reflect unique and deeply held beliefs that may be lost when averaged with the preferences of other individuals. Feminist moral theories which argue for attention to context and particularity underline the importance of ascertaining the extent to which differences in preferences for health states reveal information which is morally relevant to clinicians and policymakers. To facilitate these considerations, we present an empirical study of preferences for the timing and occurrence of health states associated with hormone replacement therapy (HRT). Sixteen women between the ages of 45 and 55 were enrolled in this pilot study. Their preferences regarding five health states associated with HRT (menopausal symptoms, side effects of HRT, breast cancer, myocardial infarction, and osteoporosis) were assessed in quantitative terms known as utilities. Two standard methods, the visual analog scale (VAS) and the standard gamble (SG), were used to assess utility and time preference (calculated as a discount rate). The wide variability of responses underlines the importance of tailoring health care to individual women's preferences. Policy guidelines which incorporate utility analysis must recognize the normative limitations of aggregated preferences, and the moral relevance of individual conceptions of health.

Original languageEnglish (US)
Pages (from-to)187-211
Number of pages25
JournalHealth Care Analysis
Issue number2
StatePublished - 2001
Externally publishedYes


  • Cost-effective analysis
  • Decision analysis
  • Distributive justice
  • Feminist theory
  • Hormone replacement therapy
  • Menopause
  • Patient preferences
  • Time preference
  • Utility
  • Women

ASJC Scopus subject areas

  • Issues, ethics and legal aspects
  • Health(social science)
  • Health Policy


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