Abstract

BackgroundIn most socialised health systems there are formal processes that manage resource scarcity and determine the allocation of funds to health services in accordance with their priority. In this analysis, part of a larger qualitative study examining the ethical issues entailed in doctors’ participation as technical experts in priority setting, we describe the values and ethical commitments of doctors who engage in priority setting and make an empirically derived contribution towards the identification of an ethical framework for doctors’ macroallocation work.MethodWe conducted semi-structured interviews with 20 doctors, each of whom participated in macroallocation at one or more levels of the Australian health system. Our sampling, data-collection, and analysis strategies were closely modelled on grounded moral analysis, an iterative empirical bioethics methodology that employs contemporaneous interchange between the ethical and empirical to support normative claims grounded in practice.ResultsThe values held in common by the doctors in our sample related to the domains of personal ethics (‘taking responsibility’ and ‘persistence, patience, and loyalty to a cause’), justice (‘engaging in distributive justice’, ‘equity’, and ‘confidence in institutions’), and practices of argumentation (‘moderation’ and ‘data and evidence’). Applying the principles of grounded moral analysis, we identified that our participants’ ideas of the good in macroallocation and their normative insights into the practice were strongly aligned with the three levels of Paul Ricoeur’s ‘little ethics’: ‘aiming at the “good life” lived with and for others in just institutions’.ConclusionsOur findings suggest new ways of understanding how doctors’ values might have procedural and substantive impacts on macroallocation, and challenge the prevailing assumption that doctors in this milieu are motivated primarily by deontological considerations. Our empirical bioethics approach enabled us to identify an ethical framework for medical work in macroallocation that was grounded in the values and ethical intuitions of doctors engaged in actions of distributive justice. The concordance between Ricoeur’s ‘little ethics’ and macroallocation practitioners’ experiences, and its embrace of mutuality, suggest that it has the potential to guide practice, support ethical reflection, and harmonise deliberative practices amongst actors in macroallocation generally.

Highlights

  • In most socialised health systems there are formal processes that manage resource scarcity and determine the allocation of funds to health services in accordance with their priority

  • Our empirical bioethics approach enabled us to identify an ethical framework for medical work in macroallocation that was grounded in the values and ethical intuitions of doctors engaged in actions of distributive justice

  • Part of a larger qualitative study undertaken in NSW, Australia, we report on the values and ethical commitments of doctors who participate in health care resource allocation processes as technical experts, and make an empirically derived contribution towards the identification of an ethical framework to guide doctors who occupy this role

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Summary

Introduction

In most socialised health systems there are formal processes that manage resource scarcity and determine the allocation of funds to health services in accordance with their priority In this analysis, part of a larger qualitative study examining the ethical issues entailed in doctors’ participation as technical experts in priority setting, we describe the values and ethical commitments of doctors who engage in priority setting and make an empirically derived contribution towards the identification of an ethical framework for doctors’ macroallocation work. Part of a larger qualitative study examining the ethical issues entailed in doctors’ participation as technical experts in priority setting, we describe the values and ethical commitments of doctors who engage in priority setting and make an empirically derived contribution towards the identification of an ethical framework for doctors’ macroallocation work It is almost universal in contemporary western societies to construct healthcare resources as scarce and in need of rationing [1]. Since it generally entails competing policy goals that require choices to be made amongst many defensible options [10] and normative assessments of the needs of groups of patients who are seen as competing for the same resources [9], it is often conceptualised as priority setting [8, 11]

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