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Justice in Access to and Distribution of Resources in Psychiatry and Mental Health Care

  • Ruud ter Meulen
Chapter
Part of the International Library of Ethics, Law, and the New Medicine book series (LIME, volume 45)

Abstract

This chapter presents an overview of general ethical principles of justice to health care, an application of these principles to resource allocation in relation with mental health care, an introduction of the concepts of necessary care and solidarity, as well as need and outcome based approaches. While the needs of mental health patients are widely recognised, needs are generally seen as subjective and difficult to distinguish from preferences or wishes of individuals. A new approach is the concept of ‘burden of disease’ which gives a measurable indication of the problems of individuals in need of treatment. Burden of disease should be combined with evidence on the effectiveness of treatments, as produced in randomised controlled trials (RCTs). The use of evidence on effectiveness and cost-effectiveness studies has become increasingly prominent in so-called evidence-based policies on resource allocation in health care, including mental health care. However, the use of evidence-based medicine in the allocation of scarce resources may lead to a one-sidedness and to unfair priorities within mental health care. The author concludes that out-come oriented approaches should be mixed with a measurement of the burden of disease and should also take into account our solidarity with the most vulnerable groups.

Keywords

Mental Health Mental Health Service Gross Domestic Product Mental Health Problem National Health Service 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

CVZ

College voor Zorgverzekeringen (Dutch Health Insurance Council)

DSM

Diagnostic and Statistic Manual, American Psychiatric Association

EbM

Evidence-Based Medicine

GDP

Gross Domestic Product

NHS

National Health Service

NICE

National Institute for Health and Clinical Excellence

OECD

Organisation for Economic Co-operation and Development

QALYs

Quality Adjusted Life Years

RCT

Randomised Controlled Trial

SSRI

Selective Serotonin Reuptake Inhibitor

References

  1. Berghmans RLP, Berg M, van de Burg M, ter Meulen RHJ (2004) Ethical issues of cost-effectiveness analysis and guideline setting in mental health care. J Med Ethics 30:146–150CrossRefGoogle Scholar
  2. Berghmans RLP, ter Meulen RHJ, Malizia A, Vos R (2010) Feeling better. Scientific, ethical and social issues in mood enhancement. In: Savulescu J, ter Meulen RHJ, Kahane G (eds) Enhancing human capacities. Blackwell, London (forthcoming)Google Scholar
  3. Boorse C (1975) On the distinction between disease and illness. Philos Public Aff 5:49–68Google Scholar
  4. Boorse C (1977) Health as a theoretical concept. Philos Sci 44:542–573CrossRefGoogle Scholar
  5. Butler J (1999) The ethics of health care rationing. Principles and practices. Cassell, LondonGoogle Scholar
  6. Committee Choices in Health Care (1991) Choices in health care. Ministry of Health, Welfare and Sports, RijswijkGoogle Scholar
  7. CVZ (2003) Ziektelast toegepast op het geneesmiddelen pakket. CVZ College voor Zorgverzekeringen, DiemenGoogle Scholar
  8. Daniels N (1985) Just health care. Cambridge University Press, CambridgeCrossRefGoogle Scholar
  9. Daniels N (2008) Just health. Meeting health needs fairly. Cambridge University Press, CambridgeGoogle Scholar
  10. Elliott C (1999) A philosophical disease: bioethics, culture and identity. Routledge, New York, LondonGoogle Scholar
  11. Elliott C (2003) Better than well: American medicine meets the American dream. Norton, New York, NYGoogle Scholar
  12. Farah MJ, Wolpe PR (2004) New neuroscience technologies and their ethical implications. Hastings Cent Rep 34(3):35–45. May–JuneCrossRefGoogle Scholar
  13. Gezondheidsraad (2003) Countouren van het basis pakket [Countours of the basic health care benefit package]. Gezondheidsraad, The HagueGoogle Scholar
  14. Harris J (1985) The value of life. Routledge, LondonGoogle Scholar
  15. Hennigsen P, Rudolf G (2000) Zur Bedeutung der Evidence-based Medicine fuer die Psychotherapeutische Medizin. Psychother Psychosom Med Psychol 50:366–375CrossRefGoogle Scholar
  16. Houtepen R, ter Meulen RHJ (2000) The expectations of solidarity: matters of justice, responsibility and identity in the reconstruction of the health care system. Health Care Anal 8:355–379CrossRefGoogle Scholar
  17. Ikkos G, Boardman J, Zigmond T (2006) Talking liberties: John Rawls’s theory of justice and psychiatric practice. Adv Psychiatr Treat 12:202–213CrossRefGoogle Scholar
  18. Jenkins R (1994) The health of the nation: recent government policy and legislation. Psychiatr Bull 18:324–327CrossRefGoogle Scholar
  19. Kramer P (1993) Listening to Prozac. Viking, New York, NYGoogle Scholar
  20. ter Meulen RHJ, Arts W, Muffels R (eds) (2001) Solidarity in health and social care in Europe. Kluwer Academic Publishers, DordrechtGoogle Scholar
  21. ter Meulen RHJ, Dickenson DL (2002) Into the hidden world behind evidence based medicine. Health Care Anal 10:231–241CrossRefGoogle Scholar
  22. OECD (2008) Health data 2008. http://www.oecd.org
  23. Parens E (ed) (1998) Enhancing human traits: ethical and social implications. Georgetown University Press, Washington, DCGoogle Scholar
  24. President’s Council on Bioethics (2003) Beyond therapy. Biotechnology and the pursuit of happiness. Regan Books, New York, NYGoogle Scholar
  25. Reis A, Lenk Ch, Reis-Streussnig C, Biller-Andorno N (2005) Evidence-based medicine in mental health: toward better and fairer treatment? In: ter Meulen RHJ, Lenk Ch, Biller-Andorno N, Lie R (eds) Ethical issues of evidence-based medicine. Springer, Berlin, pp 65–75Google Scholar
  26. Sabin JE, Daniels N (1999) Ethical issues in mental health resource allocation. In: Bloch S, Chodoff P, Green S (eds) Psychiatry ethics. Oxford University Press, OxfordGoogle Scholar
  27. Sackett DL (1996) Evidence-based medicine: what it is and what it isn’t. Br Med J 312:71–72CrossRefGoogle Scholar
  28. Van Vliet Vlieland Th (2002) Managing chronic disease: evidence-based medicine or patient centred medicine? Health Care Anal 10:289–298CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  1. 1.Centre for Ethics in MedicineUniversity of Bristol, Hampton HouseBristolUK

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