Jugglers, tightrope walkers, and ringmasters: Priority setting, allocation, and reducing moral burden

Abstract

Health system leaders, engaged in priority setting and resource allocation activities, seek means to make and justify good decisions. Values and ethics considerations can assist, but the work of developing coherent, useful ethics frameworks is just beginning. Ethical foundations underlay substantive and procedural considerations, including the need for genuine citizen involvement in priority setting activities. Difficult decisions that affect citizens, staff, and organizational partners can result in moral burden for health system leaders. Decision making based on co-determined values and inclusive processes can be expected to reduce some of that burden.