Health-care needs and shared decision-making in priority-setting
- 493 Downloads
In this paper we explore the relation between health-care needs and patients’ desires within shared decision-making (SDM) in a context of priority setting in health care. We begin by outlining some general characteristics of the concept of health-care need as well as the notions of SDM and desire. Secondly we will discuss how to distinguish between needs and desires for health care. Thirdly we present three cases which all aim to bring out and discuss a number of queries which seem to arise due to the double focus on a patient’s need and what that patient desires. These queries regard the following themes: the objectivity and moral force of needs, the prediction about what kind of patients which will appear on a micro level, implications for ranking in priority setting, difficulties regarding assessing and comparing benefits, and implications for evidence-based medicine.
KeywordsNeeds Health-care needs Shared decision-making Desires Priority setting Rationing
We would like to thank Niklas Juth, Lennart Nordenfelt, Ingemar Nordin and Gustav Tinghög for helpful discussions and comments on earlier drafts of this paper.
- Brülde, B. 1998. The human good. Göteborg: Acta Universitatis Gothoburgensis.Google Scholar
- Brülde, B. 2000a. On how to define the concept of health: A loose comparative approach. Medicine, Health Care and Philosophy 3: 305–308.Google Scholar
- Brülde, B. 2000b. More on the looser comparative approach to defining “health”: A reply to Nordenfelt’s reply. Medicine, Health Care and Philosophy 3: 313–315.Google Scholar
- Crisp, R. 2002. Treatment according to need: Justice and the British National Health Service. In Medicine and social justice: Essays on the distribution of health care, ed. R. Rhodes, 134–143. New York: Oxford University Press.Google Scholar
- Da Silva, D. 2012. Evidence: Helping people share decision making—A review of evidence considering whether shared decision making is worthwhile. London: The Health Foundation.Google Scholar
- Daniels, N. 1995. Just health care. Cambridge: Cambridge University Press.Google Scholar
- Feldman, F. 2004. Pleasure and the good life—Concerning the nature, varieties, and plausibility of hedonism. Oxford: Calderon Press.Google Scholar
- Fleischhauer, K., and G. Hermerén. 2006. Goals of medicine in the course of history and today—A study in the history and philosophy of medicine. Stockholm: Kungl. Vitterhets historie och antikvitets akademien.Google Scholar
- Griffin, J. 1986. Well-being: Its meaning, measurement, and moral importance. Oxford: Oxford University Press.Google Scholar
- Liss, P.-E. 1993. Health care need—Meaning and measurement. Aldershot: Avebury.Google Scholar
- Nordenfelt, L. 2000. On the comparative approach to defining health: A reply to Brülde. Medicine, Health Care and Philosophy 3: 309–312.Google Scholar
- Nordenfelt, L. 2007. Action, ability and health—Essays in the philosophy of action and welfare. Dordrecht: Kluwer.Google Scholar
- Parfit, D. 1984. Reasons and persons. New York: Oxford University Press.Google Scholar
- Parfit, D. 2011. On what matters. New York: Oxford University Press.Google Scholar
- Schroeder, T. 2009. Desire. Stanford encyclopedia of philosophy. http://plato.stanford.edu/entries/desire/. Accessed 3 Oct 2013.
- Sumner, L.W. 1996. Welfare, happiness & ethics. New York: Oxford University Press.Google Scholar
- Swedish Health Care Act. (1982: 763), 2 §.Google Scholar
- The NHS Constitution for England. 2013. https://www.gov.uk/government/publications/the-nhs-constitution-for-england. Accessed 25 Sept 2013.
- Thomson, G. 1987. Needs. New York: Routledge and Kegan Paul.Google Scholar
- Thomson, G. 2005. Fundamental needs. In The philosophy of need, ed. S. Reader, 175–186. Cambridge: Cambridge University.Google Scholar
- Wiggins, D. 1998. Needs, values, truth, 3rd ed. Oxford: Clarendon Press.Google Scholar