The poverty of ethical analyses in economics and the unwarranted disregard of evidence

Normative conclusions in economics are usually based upon a set of assumptions which are untenable in the health sector. Persistence with these assumptions highlights a more fundamental problem: the epistemology of normative economics—the methodology for drawing conclusions with respect to the improvement of social well-being—is itself flawed. Orthodox economics does not include a process for selecting relevant ethical assumptions or context specific ethical theories. Likewise, however, ethics as a discipline is flawed as judged by this same criterion, i.e. the ability to provide an ethical basis for economic and other analyses and which reflects defensible social values. Implicit criteria of universality and immunity from criticism, no matter how contrived the context, leaves ethical principles in an epistemological never-never land: never to be accepted because of empirical evidence about social values and never demonstrable from logical argument alone. It is suggested below that empiricism and ethical theory should be combined in a process described here as “empirical ethics”. The endpoint of the suggested process would be, as in the physical sciences, the best currently available theory or hypothesis. The procedure cannot produce certainty and is itself an epistemological theory which cannot be conclusively “proved” by logic or empiricism. It is argued that, like old age, it is nevertheless the best of the available options.