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Between Enlightenment and Disaster

Dimensions of the political Use of Knowledge


Edited By Linda Sangolt

Modern politics is highly science-dependent and knowledge-driven. What is the rightful role of expert knowledge in political life? How can the truth claims of science be reconciled with principles of democratic control and lay participatory rights in decision-making?
This collection of essays by political scientists, sociologists and economists from Germany, France and Norway provides different empirical and theoretical analyses of the complex organising and legitimising power of knowledge in political governance. The authors shed light on key dimensions and dilemmas that have shaped the world-changing interrelations between politics, social institutions and scientific knowledge in the past century.
The contributions cover issue-areas and policy-fields such as population control, health economics, ICTs and higher education reform, and the politics of productivity and economic pre-eminence.


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Is it Healthy to Measure?A Systematic Analogy between Harsanyi'sSocial Choice Theory and the Standard GambleQuality Adjusted Life Years (QALY) 131


Is it Healthy to Measure? A Systematic Analogy between Harsanyi's Social Choice Theory and the Standard Gamble Quality Adjusted Life Years (QALY) Bettina WISTRÖM Introduction Is it healthy to measure? 1 wish to show that it is a risky business by drawing a systematic analogy between John Harsanyi's utilitarian social choice theory (1953; 1955) and the Quality Adjusted Life Years (QALY) efficiency criterion, which is considered as the "best" application of the concept of utility in health economics.' The aim is to shed light on some assumptions and problems encountered by the proponents of this recent health distribution criterion with reference to Harsanyi's social choice theory. When John Harsanyi (1982: 43) presented an assessment of his work in "Morality and the Theory of Rational Behavior," he ventured that he had worked out a "general theory of rational behavior," combining the three discipl ines of game theory, decision theory and ethics. The Quality Adjusted Life Years (QALY) efficiency criterion is notorious for having been tried out in Oregon's health service in the early 1990s where it was criticised for discriminating against the elderly and the disabled because they were considered poor "producers" of utility, (i.e. quality and length of life) compared to younger and healthier persons (Hadorn, 1991). 1 aim to show that extant knowledge of Harsanyi's well-known utilitarian theory should have helped decision-makers to anticipate the controversy that led ultimately to the rejection of this measure in Oregon. The moral problems inherent in applying Harsanyi's theory, and which were...

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