Endogenous Inequality Aversion: Decision criteria for triage and other ethical tradeoffs

Abstract

Medical "Crisis Standards of Care" call for a utilitarian allocation of scarce resources in emergencies, while favoring the worst-off under normal conditions. Inspired by such triage rules, we introduce social welfare functions whose distributive tradeoffs depend on the prevailing level of aggregate welfare. These functions are inherently self-referential: they take the welfare level as an input, even though that level is itself determined by the function. In our formulation, inequality aversion varies with welfare and is therefore self-referential. We provide an axiomatic foundation for a family of social welfare functions that move from Rawlsian to utilitarian criteria as overall welfare falls, thereby formalizing triage guidelines. We also derive the converse case, in which the social objective shifts from Rawlsianism toward utilitarianism as welfare increases.