Public healthcare resource allocation and the Rule of Rescue
Public healthcare resource allocation and the Rule of Rescue
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DOI：
10.1136/jme.2007.021790
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发表时间：
2008-07-01
影响因子：
4.1
通讯作者：
Tsuchiya, A.
中科院分区：
文献类型：
--
作者：
Cookson, R.;McCabe, C.;Tsuchiya, A.
在医疗保健中，有时会出现一种紧张关系，即用稀缺资源做尽可能多的好事的禁令和不计成本拯救处于直接危险中的可识别个人的禁令（“救援规则”）。这种紧张关系可能会给公共政策制定者带来严重的伦理和政治困难，他们面临着对有争议的卫生技术（如昂贵的新抗癌药物）的公共资金做出明确决定的问题。在本文中，我们探讨了适当的作用规则的救援公共资源分配的决定，卫生技术资助咨询机构，如国家卫生和临床优化研究所。我们认为，实用的方法来操作的规则，从澳大利亚和英国的救援之前，检查个人的道德义务的相关性，公共政策的制定。我们的结论是，虽然公共政策制定者在一个人道的社会应该促进特殊偏离成本效益规范的临床决策确定个人，这是不那么明显，他们应该作为一个国家的公共政策问题，免除任何一组身份不明的个人在社会中的机会成本的规则，在牺牲所有其他人。
In healthcare, a tension sometimes arises between the injunction to do as much good as possible with scarce resources and the injunction to rescue identifiable individuals in immediate peril, regardless of cost (the '' Rule of Rescue''). This tension can generate serious ethical and political difficulties for public policy makers faced with making explicit decisions about the public funding of controversial health technologies, such as costly new cancer drugs. In this paper we explore the appropriate role of the Rule of Rescue in public resource allocation decisions by health technology funding advisory bodies such as the National Institute for Health and Clinical Excellence. We consider practical approaches to operationalising the Rule of Rescue from Australia and the UK before examining the relevance of individual moral imperatives to public policy making. We conclude that that whilst public policy makers in a humane society should facilitate exceptional departures from a cost effectiveness norm in clinical decisions about identified individuals, it is not so obvious that they should, as a matter of national public policy, exempt any one group of unidentified individuals within society from the rules of opportunity cost at the expense of all others.