The past decade has seen a proliferation of value assessment frameworks (VAFs) to determine how to pay for value. Ethical issues are inherent by the very nature of defining value and therefore critical when a VAF’s purpose is to determine compensation for healthcare services. For example, patients with multiple chronic and complex conditions who are unlikely to return to “health” may be less valuable to healthcare systems. We examined 22 recently published VAFs to determine what ethical considerations were accounted for in their definition of value. Utilitarianism, maximizing health gains for the greatest number, was the most referenced (implicitly or explicitly) ethical framework (10). Three of the VAFs identified ethical considerations as important though did not elaborate further. Two VAFs stated a medical ethicist was to be consulted, and one stated that ethical considerations will be addressed in the future. The remaining six did not mention any ethical considerations implicitly or explicitly. The VAFs also differed on the perspective (patient, society, payer, or provider) that should be given priority. The primary perspective was societal in nine of the VAFs, and a patient perspective was primary in five. The remaining six stated that multiple perspectives should be considered. Though a plurality of VAFs referenced utilitarianism, none addressed the practical limitations of balancing health needs and payment. A utilitarian framework may lead to maximizing gains of the healthier, non-chronically ill rather than eliminating suffering in populations whose health needs are more expensive. A different ethical framework, such as deontology (never commit an act that violates moral law regardless of outcome) may lead to a very different VAF structure. If the underlying ethical considerations and primacy of perspective are ignored in the definition of value, it is difficult to understand how the current VAFs will increase the value of healthcare.