Accountability for reasonableness: the relevance, or not, of exceptionality in resource allocation
Accountability for Reasonableness has gained international acceptance as a framework to assist with resource allocation within healthcare. Despite this, one of the four conditions, the relevance condition, has not been widely adopted. In this paper I will start by examining the relevance condition, and the constraints placed on it by Daniels and Sabin. Following this, I review the theoretical limitations of the condition identified to date, by prominent critics such as Rid, Friedman, Lauridsen and Lippert—Rasmussen. Finally, I respond to Daniels and Sabin’s enthusiasm for testing the accountability for reasonableness framework in different contexts, by evaluating the challenges of implementing the relevance condition within the NHS. I use the funding of treatments for patients on the basis of their exceptional circumstances as a case study to examine whether the relevance condition could be applied in practice.
KeywordsAccountability for reasonableness Relevance condition Exceptionality Resource allocation Ethical framework
- Concise Oxford Dictionary. 2006. 11th edn. Oxford: OUP.Google Scholar
- Daniels, N. 2008. Just health: Meeting health needs fairly. Cambridge: Cambridge University Press.Google Scholar
- N. Daniels. 2009. Just Health: Replies and further thoughts. JME 35: 36–41.Google Scholar
- Daniels, N., and J. Sabin. 2008. Setting limits fairly: Learning to share resources for health, 2nd ed. Oxford: Oxford University Press.Google Scholar
- Department of Health. Alan Angilley. July 2003. Directions to primary care trusts in England concerning arrangements for the funding of technology appraisal guidance from the national institute for clinical excellence. Available at http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4075686.pdf. Accessed 17 July 2008.
- Department of Health. The NHS Plan: A plan for investment, a plan for reform (Cm; 4818 I). July 2009.Google Scholar
- Department of Health. January 2009. Defining guiding principles for processes supporting local decision making about medicine. Department of Health. March 2010. The NHS Constitution. Google Scholar
- Department of Health, UK Blood Transfusion & Tissue Transplantation ‘Better Blood Transfusion; appropriate use of blood’. 2011 http://www.transfusionguidelines.org.uk/index.aspx?Publication=BBT&Section=22&pageid=1352. Accessed 26 April 2012.
- Harris, J. 1987. QALYfying the value of life. JME 13: 117–123.Google Scholar
- Harris, J. 1992. Unprincipled QALYs. JME 18: 162.Google Scholar
- Lockwood, M. 1998. Quality of life and resource allocation. In Philosophy and medical welfare, ed. J. Bell, and S. Mendus, 33–55. Cambridge: Cambridge University Press.Google Scholar
- Menzel, P.T. 1990. Strong medicine: The ethical rationing of health care, 11–12. New York: Oxford University Press.Google Scholar
- The NHS Confederation. 2008. Priority setting: Managing individual funding requests: 4 Available at http://www.nhsconfed.org/publications/prioritysetting/pages/prioritysettingfunding.aspx. Accessed 7 July 2010.
- National Institute for Health and Clinical Excellence. (2008). Social value judgements: Principles for the development of NICE guidance. 2nd Edition.Google Scholar
- National Prescribing Centre (NPC). 2009. A comprehensive survey of PCTs to evaluate local decision-making processes for funding new medicines. Available at: http://www.npc.co.uk/local_decision_making/resources/npc_survey_report.pdf. Accessed 9 January 2012.
- National Prescribing Centre. (2009). Supporting rational local decision-making about medicines (and treatments). A hand book of good practice guidance. Google Scholar
- Rawls, J. 1971. A theory of justice, 83–90. Cambridge: Harvard University Press.Google Scholar
- J. Russell, T. Greenhalgh, A. Burnett, J. Montgomery. 2011. No decisions about us without us? Individual healthcare rationing in a fiscal ice age. BMJ 342: d3279.Google Scholar
- Savulescu, J. 1998. The cost of refusing treatment and equality of outcome. JME 24: 231–236.Google Scholar
- Welsh, P. 2008. Sutent battle cost more than drug. Manchester Evening News. Available at http://menmedia.co.uk/news/s/1083449_sutent_battle_cost_more_than_drug. Accessed 22 July 2010.
- Williams, A. 1985. The value of QALYs. Health and Science Service Journal 51: 3–5.Google Scholar