Intended for healthcare professionals

Letters

Public discussion of rationing decisions is essential

BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7024.184 (Published 20 January 1996) Cite this as: BMJ 1996;312:184
  1. Chris Ham
  1. Director University of Birmingham, Health Services Management Centre, Birmingham B15 2RT

    EDITOR,—David J Hunter offers an eloquent defence of “muddling through elegantly” in the cause of health care rationing or priority setting.1 Yet in counselling against a national debate on priority setting he confuses different aspects of the priority setting process. Decisions by clinicians on whether and how to treat individual patients do not need to be open to public scrutiny and are best made implicitly. The same does not apply to decision making at the level of health authorities or government. It is here that both transparency and public debate are essential. As Rudolf Klein comments in his editorial in the same issue, other countries have shown how this can be done.2

    To argue against public discussion is to run the risk of paternalism of the worst kind. Decisions on priorities for communities and whole populations involve value judgments that are too important to be left to professionals. It is all the more important, therefore, that these decisions involve as wide a set of interests as possible. The outcome may not always satisfy the experts, but this is always a risk in a democratic process.

    References

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