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Ethically acceptable prioritisation of childless couples and treatment rationing: "accountability for reasonableness".

https://arctichealth.org/en/permalink/ahliterature93294
Source
Eur J Obstet Gynecol Reprod Biol. 2008 Aug;139(2):176-86
Publication Type
Article
Date
Aug-2008
Author
Lindström Håkan
Waldau Susanne
Author Affiliation
Gyn-Obst. Unit, Skellefteå Hospital, Sweden.
Source
Eur J Obstet Gynecol Reprod Biol. 2008 Aug;139(2):176-86
Date
Aug-2008
Language
English
Publication Type
Article
Keywords
Adult
Decision Support Techniques
Evidence-Based Medicine
Female
Fertilization in Vitro
Health Care Rationing - ethics - legislation & jurisprudence
Health Priorities - ethics - legislation & jurisprudence
Humans
Infertility - diagnosis - therapy
Male
Middle Aged
Models, Theoretical
Sweden
Abstract
OBJECTIVE: With in vitro fertilisation serving as a specific case, an intervention was aimed at investigating the potential for applying prioritisation theories and methods in a real-life situation to form an evidence-based proposal that met the standards of the "Accountability for Reasonableness" Model. In turn, this case would serve as a basis for public decision on rationalisation, prioritisation and rationing, whereby given resources are allocated with respect to the ethical template of the Swedish Parliament's decision on priorities in health care. STUDY DESIGN: Management representatives of the overall county council as well as the gynaecologic-obstetric department levels, infertility treatment professionals and a patients' organisation representative worked together to create guidelines building on the ethical principles of human dignity, needs/solidarity and cost-effectiveness, on evidence of treatment effect, epidemiology and economic resources availability. Also quality improvement techniques were used. RESULTS: Due to new guidelines for priority setting, it is expected that more childless couples in the studied health care region will get publicly financed IVF treatment. IVF treatment outcome is expected to be more cost-effective in terms of pregnancies for a given amount of resources. A balance between needs - as defined by the guidelines' criteria - and resources is expected and thus waiting lists are expected to vanish. The patients' organisations representative accepted the guidelines. They were also accepted by all obstetric clinics and formally agreed upon by the political boards of all county councils in the region. CONCLUSION: Use of a deliberative decisions model, structured quality improvement methodology and an accepted model for prioritisation helped create a system for legitimate prioritisation of couples and rationing of treatment regarding a group of patients where differentiation has been considered difficult.
PubMed ID
18417271 View in PubMed
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Hard choices in public health: the allocation of scarce resources.

https://arctichealth.org/en/permalink/ahliterature185399
Source
Scand J Public Health. 2003;31(2):156-7
Publication Type
Article
Date
2003
Author
Per-Erik Liss
Author Affiliation
Department of Health and Society, Linköping University, Linköping, Sweden. pelis@tema.liu.se
Source
Scand J Public Health. 2003;31(2):156-7
Date
2003
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Cost-Benefit Analysis
Decision Making, Organizational
Health Care Rationing - ethics - legislation & jurisprudence
Health Priorities
Humans
Occupational Health
Policy Making
Public Health - legislation & jurisprudence
Sweden
PubMed ID
12745767 View in PubMed
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Principles versus procedures in making health care coverage decisions: addressing inevitable conflicts.

https://arctichealth.org/en/permalink/ahliterature156832
Source
Theor Med Bioeth. 2008;29(2):73-85
Publication Type
Article
Date
2008
Author
Lindsay M Sabik
Reidar K Lie
Author Affiliation
Department of Bioethics, National Institutes of Health, Bethesda, MD 20892, USA.
Source
Theor Med Bioeth. 2008;29(2):73-85
Date
2008
Language
English
Publication Type
Article
Keywords
Conflict (Psychology)
Conflict of Interest
Decision Making
Ethical Analysis
Ethical Theory
Great Britain
Health Care Rationing - ethics - legislation & jurisprudence
Health Maintenance Organizations - ethics - legislation & jurisprudence
Humans
Insurance Coverage - ethics - legislation & jurisprudence
Medical Laboratory Science - ethics - legislation & jurisprudence
Norway
Patient Rights - ethics - legislation & jurisprudence
Principle-Based Ethics
Social Justice
Social Responsibility
United States
Withholding Treatment - ethics - legislation & jurisprudence
Abstract
It has been suggested that focusing on procedures when setting priorities for health care avoids the conflicts that arise when attempting to agree on principles. A prominent example of this approach is "accountability for reasonableness." We will argue that the same problem arises with procedural accounts; reasonable people will disagree about central elements in the process. We consider the procedural condition of appeal process and three examples of conflicts over coverage decisions: a patients' rights law in Norway, health technologies coverage recommendations in the UK, and care withheld by HMOs in the US. In each case a process is at the center of controversy, illustrating the difficulties in establishing procedures that are widely accepted as legitimate. Further work must be done in developing procedural frameworks.
PubMed ID
18535922 View in PubMed
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