Recently there has been a refusal at the European level to intervene on the issue of the pricing of medicines in Malta alleged to be several times higher than in other European countries. There has also been a rumpus about lack of stents for treatment of circulation problems also due to financial complications. Have you any observations on these subjects especially from the point of view of social ethics?

A source of general unhappiness about these matters is surely our lack of knowledge of what policies there are and how they are established.

Most of us readily assume that it is not possible for the State to provide all the medicines and treatment that doctors would ideally prescribe if there were no financial constraints.

That is also the case even in the most comprehensive of welfare states. Indeed Christian Leonard of the Belgian Health Care Knowledge Centre has said: "Our health 'care' system has become a distribution and rationing service."

However, in most European countries there are at least well established and well-known criteria that are applied by specifically designated authorities such as the Haute Autorité de santé in France to regulate what medicines or other treatment is given to whom.

In England, a system called Qaly (Quality Adjusted Life Years), was developed. This system gives a numerical value from zero to one, (where one indicates perfect health and zero a state equivalent to death) to an individual at a certain time. This figure is arrived at by taking into account at the same time the improvement in health that the medicine or other treatment is calculated to bring about and the expected duration of this improvement (quality of life).

In consequence of this system, priority is obviously given to the young. Almost equally obviously, priority goes to those who have taken good care of their health. In France, in 2006, patients who showed a lack of compliance with official health guidelines were penalised by 20 per cent of their entitlement.

The stated aim of Qaly type indexes is "health maximisation", but a question has been raised: Is it equitable always to give priority to those patients for whom the treatment is most effective?

Many states are modifying the Qaly approach by introducing criteria which they describe as based on "empirical ethics". Since it is no longer possible today in most European countries to assume there are agreed ethical principles, attempts are made to establish what the majority believe are the moral values to be upheld. The usual methods used by sociologists such as the so-called "citizens jury" or focus groups are applied to ascertain the ethical preferences of people.

What are the results of these enquiries?

The research done in this regard, as appears for instance in the Handbook of Health Economics (2000) edited by Culyer and Newhouse and in Distributing Health Care by Dolan and Olsen (2002), early on showed that people favour principles that are not always those of health maximisation. For instance, they hold that priority should be given to people whose life expectancy would be low unless they were given the treatment. In general, people prefer equity over efficiency.

There are four main theories as to what constitutes equity in resource distribution with regard to health:

The first is "equality of expenditure per head". I confess I was surprised to read in the best study on the subject to my knowledge that most people favour this almost fundamentalist egalitarianism.

The second is "equality of treatment for equal need". The case for this approach is argued by such social policy experts as Lookwood and Broome. The major problem with this is the notorious difficulty of defining and measuring need.

The third is "equality of access" which is ideologically the equivalent of "equality of opportunity" applied to the health sector. This approach is notably argued for by Mooney and Le Grand.

The fourth is "health equality". The basis of this thesis is that the distribution of health resources should aim primarily to reduce health inequalities in order to reach ideally equal life expectation at birth for everyone. A. Williams has presented the case for what he calls "fair innings" illustrated for the UK.

Ethical criteria of this kind were introduced in the UK National Health Service following the publication of the White Book Local Voices in 1992. Consequently, Qalys at the individual level are weighted in terms of social value - i.e. benefit to the collectivity. To do this Nord has advocated a "person trade-off" method.

For almost a decade from its inception until 1996 you were on the governing board of the Foundation for Medical Sciences and Services. In the Islamic tradition down to our day philosophers and medics are in principle in the same business: anthropology. Does this explain your personal involvement in this matter?

The health industry has certainly succeeded in bringing about a philosophical revolution in our day. The generally held picture of what it means to be a human being has been shifted. The classical image of man was that of a tragicomic actor (some of whose blunders bring suffering, while others provoke laughter). The new image almost universally defused by the Health Industry is that of a needy patient on perpetual lookout for some technical means of evasion from pain.

Fr Peter Serracino Inglott was talking to Miriam Vincenti.