Journal of Medical Ethics · 1992 · 207 citations · 2 references
PharmacyHealth PolicyPharmacoeconomicsCost-effectiveness AnalysisHealth EconomicsMedical EthicsCost MeasurementEconomic EvaluationHealthcare Cost AnalysisHealthcare EthicsPharmacoeconomic EvaluationBias In Economic EvaluationCost-effectivenessMedical Cost AnalysisMethods Of Economic EvaluationPolicy ContextQuestioning AssumptionsSurvival Rates
Clinicians often view cost considerations as unethical, yet ignoring costs is also unethical, and determining which costs and benefits to count raises ethical dilemmas similar to those surrounding benefit criteria such as survival rates. Systematic cost‑effectiveness analysis exposes hidden assumptions and forces explicit ethical judgments about appropriate positions in policy contexts. This approach also improves policy‑makers’ accountability to the communities they serve.
Many clinicians believe that allowing costs to influence clinical decisions is unethical. They are mistaken in this belief, because it cannot be ethical to ignore the adverse consequences upon others of the decisions you make, which is what 'costs' represent. There are, however, some important ethical issues in deciding what costs to count, and how to count them. But these dilemmas are equally strong with respect to what benefits to count and how to count them, some of which expose ethically untenable assumptions about such widely-used clinical criteria as survival rates. One of the advantages of systematic cost-effectiveness analysis is that it exposes these hidden assumptions, and requires explicit judgements to be made about which ethical position is appropriate in a particular policy context. This should have the important incidental benefit of improving the accountability of policy-makers to the community they are serving.
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