Medicine, Health Care and Philosophy

, Volume 18, Issue 2, pp 217–227 | Cite as

Accountability for reasonableness: the relevance, or not, of exceptionality in resource allocation

  • Amy FordEmail author
Scientific Contribution


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.


Accountability for reasonableness Relevance condition Exceptionality Resource allocation Ethical framework 



I am grateful to Professor John Harris, and two anonymous peer reviewers, for their comments on earlier drafts of this paper.


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Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  1. 1.School of LawUniversity of ManchesterManchesterUK

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