Commercialism, Holism, and Individual Responsibility Comment on “Buying Health: The Costs of Commercialism and an Alternative Philosophy”

Churchill and Churchill’s editorial discusses negative (health) effects of commercialism in the provision of health care and nutrition. Three parts of their argument are commented: the claim that the fundamental problem of markets is the decomposition of the whole into parts (“reductionism”); the call for individual responsibility; and the notion of holism. On the three aspects the commentary concludes thus: Because provision of health and food must be controlled and managed in some form, an alternative to some kind of decomposition is hard to see. The call for individual responsibility is controversial due to its lack of attention to socioeconomic inequalities. The concept of “holism” is problematic due to its epistemological and normative statu

VERDIEN AV LIV OG HELSE Hvor mye bør samfunnet være villig til å betale for helseforbedringer?

Økonomisk evaluering er et verktøy som har fått økende anvendelse som beslutningsgrunnlag ved prioriteringer i helsevesenet. Fordi det er knapphet på ressurser er det nødvendig å vurdere om nytten av ressursbruken eller ressursfordelingen står i et akseptabelt forhold til kostnadene. Det ville være uetisk å ignorere kostnaden ved en gitt helsetjeneste; det innebærer å ignorere spørsmålet om ressursbruken kunne gitt mer nytte i form av helseforbedring eller livredning for andre pasienter. Likevel reiser økonomiske analyser en rekke problemer av etisk, økonomisk-teoretisk, metodologisk og praktisk art. Senter for medisinsk metodevurdering (SMM), Helseøkonomiprogrammet ved Universitetet i Oslo (HERO) og Sosial- og helsedirektoratet (SHD) besluttet derfor våren 2002 å arrangere en konferanse der man ville drøfte noen av de vanskelige problemene knyttet til økonomisk evaluering og prioritering. Man inviterte politikere fra alle politiske fløyer og fagfolk med svært ulik tilnærming slik det fremgår av programmet. I denne rapporten legger vi frem skriftlige bidrag fra de fleste av foredragsholderne. En redaksjonskomite bestående av Berit Bringedal, Tor Iversen og Ivar Sønbø Kristiansen har redigert rapporten sammen med informasjonsmedarbeiderne Dagny Fredheim og Gunn Kristin Tjoflot. Redaksjonsarbeidet har begrenset seg til forslag om klargjøring av argumenter og enhetlig grafisk layout. Forfatterne har stått fritt til å uttrykke sine meninger, og disse står for enkeltpersonenes regning, ikke for deres arbeidsgiveres. Konferansen vakte stor interesse med ca 170 påmeldte deltakere. Mens mange av foredragsholderne hadde fått i oppdrag å vurdere grenser for samfunnets betalingsvilje for liv og helseforbedringer, ønsket de selv i liten grad å uttrykke seg konkret om dette. Artiklene belyser likevel en rekke teoretiske og praktiske aspekter ved økonomisk evaluering og prioritering. Rapporten gir et bilde av viktige helseøkonomiske problemstillinger, samt noen av de sentrale problemene knyttet til økonomiske analyser av helsetiltak. Vi håper rapporten kan være nyttig for alle som skal bruke økonomisk evaluering i sitt arbeide.Økonomisk evaluering; prioritering; helse

An empirical bioethical examination of Norwegian and British doctors' views of responsibility and (de)prioritization in healthcare

In a world with limited resources, allocation of resources to certain individuals and conditions inevitably means fewer resources allocated to other individuals and conditions. Should a patient's personal responsibility be relevant to decisions re- garding allocation? In this project we combine the normative and the descriptive, conducting an empirical bioethical examination of how both Norwegian and British doctors think about principles of responsibility in allocating scarce healthcare re- sources. A large proportion of doctors in both countries supported including re- sponsibility for illness in prioritization decisions. This finding was more prominent in zero‐sum scenarios where allocation to one patient means that another patient is denied treatment. There was most support for incorporating prospective responsi- bility (through patient contracts), and low support for integrating responsibility into co‐payments (i.e. through requiring responsible patients to pay part of the costs of treatment). Finally, some behaviours were considered more appropriate grounds for deprioritization (smoking, alcohol, drug use)—potentially because of the certainty of impact and direct link to ill health. In zero‐sum situations, prognosis also influenced prioritization (but did not outweigh responsibility). Ethical implications are discussed. We argue that the role that responsibility constructs appear to play in doctors' decisions indicates a needs for more nuanced—and clear—policy. Such policy should account for the distinctions we draw between responsibility‐sensitive and prog- nostic justifications for deprioritization

From Responsible Research and Innovation to Responsibility by Design

open access articleDrawing on more than eight years working to implement Responsible Research and Innovation (RRI) in the Human Brain Project, a large EU-funded research project that brings together neuroscience, computing, social sciences, and the humanities, and one of the largest investments in RRI in one project, this article offers insights on RRI and explores its possible future. We focus on the question of how RRI can have long-lasting impact and persist beyond the time horizon of funded projects. For this purpose, we suggest the concept of “responsibility by design” which is intended to encapsulate the idea of embedding RRI in research and innovation in a way that makes it part of the fabric of the resulting outcomes, in our case, a distributed European Research Infrastructure

Commercialism, Holism, and Individual Responsibility; Comment on “Buying Health: The Costs of Commercialism and an Alternative Philosophy”

Churchill and Churchill’s editorial discusses negative (health) effects of commercialism in the provision of health care and nutrition. Three parts of their argument are commented: the claim that the fundamental problem of markets is the decomposition of the whole into parts (“reductionism”); the call for individual responsibility; and the notion of holism. On the three aspects the commentary concludes thus: Because provision of health and food must be controlled and managed in some form, an alternative to some kind of decomposition is hard to see. The call for individual responsibility is controversial due to its lack of attention to socioeconomic inequalities. The concept of “holism” is problematic due to its epistemological and normative status

Guest Editor's Introduction

The paper provides an introduction to the special issue, as well as an overview of the collection of papers

Distribution Principles in Health Care

What ethical considerations are made in decisions on distribution of scarce health care resources? Are the distributional decisions consciously based on explicit ethical principles, and if so, what principles? Both theoretical and political arguments on distribution of scarce medical resources frequently make simultaneous considerations of costs, probability of positive effects of medical treatment, and ethical values, possibly sacrificing explicit formulation of the ethical problem (or each element in general). To explicate the normative problem, it is convenient to distinguish between the three parts. A model of elements in the decision problem is presented. These elements are: Costs (C), probability of positive effect of treatment (P), and the (ethical) values related to the treatment of an individual (V). Stipulation of values on C, P, and V, respectively, is further discussed; ethical considerations (V) are the primary focus. Arguments for specific distributional principles are distinguished depending on whether the basis is P, V or C

Guest Editor's Introduction

The paper provides an introduction to the special issue, as well as an overview of the collection of papers