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

Scientific Contribution

Abstract

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.

Keywords

Accountability for reasonableness Relevance condition Exceptionality Resource allocation Ethical framework 

References

  1. Callahan, D. 2011. Rationing: Theory, politics, and passions. Hastings Center Report 41(2): 23–27.CrossRefGoogle Scholar
  2. Concise Oxford Dictionary. 2006. 11th edn. Oxford: OUP.Google Scholar
  3. Daniels, N. 2008. Just health: Meeting health needs fairly. Cambridge: Cambridge University Press.Google Scholar
  4. N. Daniels. 2009. Just Health: Replies and further thoughts. JME 35: 36–41.Google Scholar
  5. Daniels, N. 2000. Accountability for reasonableness. BMJ 321: 1300–1301.CrossRefGoogle Scholar
  6. Daniels, N., and J. Sabin. 2008. Setting limits fairly: Learning to share resources for health, 2nd ed. Oxford: Oxford University Press.Google Scholar
  7. 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.
  8. Department of Health. The NHS Plan: A plan for investment, a plan for reform (Cm; 4818 I). July 2009.Google Scholar
  9. 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
  10. 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.
  11. Friedman, A. 2008. Beyond Accountability for Reasonableness. Bioethics 22: 101–112.CrossRefGoogle Scholar
  12. Ford, A. 2012. The concept of exceptionality: A legal farce? Medical Law Review 20(3): 304–336.CrossRefGoogle Scholar
  13. Gibson, J., D. Martin, and P. Singer. 2002. Priority setting for new technologies in medicine: A transdisciplinary study. BMC Health Serv Res 2: 14.CrossRefGoogle Scholar
  14. Harris, J. 1987. QALYfying the value of life. JME 13: 117–123.Google Scholar
  15. Harris, J. 1992. Unprincipled QALYs. JME 18: 162.Google Scholar
  16. Harris, J. 1997. The rationing debate: Maximising the health of the whole community. The case against: What the principal objective of the NHS should really be. BMJ 314: 669.CrossRefGoogle Scholar
  17. Harris, J., and S. Regmi. 2012. Ageism and equality. Journal of Medical Ethics 38: 263–266.CrossRefGoogle Scholar
  18. Hasman, A., and S. Holm. 2005. Accountability for reasonableness: Opening the black box of process. Health Care Analysis 13: 261–273.CrossRefGoogle Scholar
  19. Kapiriri, L., O.F. Norheim, and D.K. Martin. 2009. Fairness and accountability for reasonableness. Do the views of priority setting decision makers differ across health systems and levels of decision making? Social Science and Medicine 68: 766–773.CrossRefGoogle Scholar
  20. Lauridsen, S., and K. Lippert-Rasmussen. 2009. Legitimate allocation of public healthcare: Beyond accountability for reasonableness. Public Health Ethics 2: 59–69.CrossRefGoogle Scholar
  21. 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
  22. Martin, D., and P. Singer. 2003. A strategy to improve priority setting in health care institutions. Health Care Analysis 11: 59–68.CrossRefGoogle Scholar
  23. Menzel, P.T. 1990. Strong medicine: The ethical rationing of health care, 11–12. New York: Oxford University Press.Google Scholar
  24. Mielke, J., D.K. Martin, and P.A. Singer. 2003. Priority setting in a hospital critical care unit: Qualitative case study. Critical Care Med 31: 2764–2768.CrossRefGoogle Scholar
  25. 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.
  26. National Institute for Health and Clinical Excellence. (2008). Social value judgements: Principles for the development of NICE guidance. 2nd Edition.Google Scholar
  27. 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.
  28. National Prescribing Centre. (2009). Supporting rational local decision-making about medicines (and treatments). A hand book of good practice guidance. Google Scholar
  29. Rawls, J. 1971. A theory of justice, 83–90. Cambridge: Harvard University Press.Google Scholar
  30. Rid, A. 2009. Justice and procedure: How does ‘accountability for reasonableness’ result in fair limit-setting decisions? Journal of Medical Ethics 35: 12–16.CrossRefGoogle Scholar
  31. 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
  32. Sabik, L., and R. Lie. 2008. Principles versus procedures in making healthcare coverage decisions: Addressing inevitable conflicts. Theoretical Medicine and Bioethics 29: 73–85.CrossRefGoogle Scholar
  33. Savulescu, J. 1998. The cost of refusing treatment and equality of outcome. JME 24: 231–236.Google Scholar
  34. Singer, P.A. 2000. Recent advances: Medical ethics. BMJ 321: 282–285.CrossRefGoogle Scholar
  35. Singer, P.A., D.K. Martin, M. Giacomini, and L. Purdy. 2000. Priority setting for new technologies in medicine: Qualitative case study. BMJ 321: 1316–1318.CrossRefGoogle Scholar
  36. Torgerson, D.J., and T. Gosden. 2000. Priority setting in health care: Should we ask the tax payer? BMJ 320: 1679.CrossRefGoogle Scholar
  37. 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.
  38. Williams, A. 1985. The value of QALYs. Health and Science Service Journal 51: 3–5.Google Scholar
  39. Wolf, S. 1992. Two levels of pluralism. Ethics 102: 785–798.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  1. 1.School of LawUniversity of ManchesterManchesterUK

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