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Guidelines and Policies

Ethical considerations relating to health care resource allocation decisions
NHMRC Guideline

Legislation

Health Services Act 1997 NSW
Legislation for the structure of public health services in NSW. Requires all practitioners and employees to disclose any charges or convictions of serious sex or violence offences.

Toolkits and Protocols

Ethics and Resource Allocation UK
UK Clinical Ethics Network
An educational resource on the ethics of resource allocation.

Ethical considerations relating to health care resource allocation decisions Cth
NHMRC
The Australian Health Ethics Committee is concerned with the ethical implications of medical research and practice and of health care in general. One of the committee’s major current interests is in the ethics of health care resource allocation. This is the second paper of a series on this topic.

National Statement on Ethical Conduct in Human Research Cth
NHMRC
A series of guidelines re research. Also provides information on requirements for quality assurance audits to develop understanding what activities may or may not need to undergo ethical review.

Resource Allocation: UK Clinical Ethics Network UK
UK Clinical Ethics Network
Overview of legal and ethical issues in resource allocation.

Cases


R v Central Birmingham Health Authority; ex p Collier (‘Collier’)
(unreported, Court of Appeal, 6 January 1988)  UK

The father of an infant sought the court’s intervention in a series of decisions not to give an ‘urgent operation’ for a heart bypass. Significantly, no evidence was led as to why the operation was repeatedly cancelled. Stephen Brown LJ said that the court was not a position to judge allocation issues.

R v Central Birmingham Health Authority; R v Secretary of State for Social Services; ex p Walker (‘Walker’) (1987) 3 BMLR 32  UK
Mrs Walker applied to the court for the judicial review of a decision by the central Birmingham Health Authority not to treat her baby son for a heart operation. The mother sought a court order that the operation take place at once. She failed both at first instance and on appeal on the grounds that the decision not to treat was based on resource allocation priorities.

R v Cambridge Health Authority; ex p B [1995] 1 WLR 898 UK
Case concerned the decision of a health authority not to provide funds for the treatment of a 10-year-old girl who had non- Hodgkin’s leukaemia and who had come out of remission. At first instance the decision was quashed on four grounds including that the authority’s decision failed to take into account the wishes of the patient, as expressed through her family, in particular, her father and the authority’s decision was said to be manifestly Wednesbury unreasonable. The Court of Appeal overturned the trial judge’s decision on the grounds of non-justiciability. Again it was found that it was not the court’s role to question allocation decisions.

R v Derbyshire HA; ex p Fisher [1997] 8 Med LR 327  UK
A local authority had limited the use of beta interferon to treatments that were part of a randomised trial of the drug. No such trial was in existence and there was little if any chance that one would be implemented. Regardless of this fact, the authority insisted on withholding funds for the use of the drug unless treatment was part of a trial. The policy was found to be irrational and unreasonable. It was also in contravention of a departmental directive to provide funding for such treatments.

R (Rogers) v Swindon NHS Primary Trust [2006] EWCA Civ 392 UK
The Court of Appeal said that if a policy made it impossible to satisfy ‘exceptional circumstances’ it would effectively be a blanket refusal and therefore irrational.

AC v Berkshire West Primary Care Trust [2010] EWHC 1162 (Admin) UK
A decision not to fund breast augmentation surgery for a transsexual was upheld on the grounds that the policy regarding such treatments was reasonable and had been applied fairly.

R (Otley) v Barking & Dagenham NHS Primary Care Trust [2007] EWHC 1927 (Admin) UK
Mitting J struck down a decision not to fund a new tumour-shrinking drug, Avastin, on a woman with advanced colorectal cancer and tumours in her liver, who had reacted badly to chemotherapy.

R (Murphy) v Salford Primary Care Trust [2008] EWHC 1908 (Admin) UK
Where the applicant had run out of treatments for her kidney cancer. She wished to have a new drug treatment (Sunitinib), but the local authority refused to fund it.

R (Ross) v West Sussex Primary Care Trust [2008] EWHC 2252 (Admin) UK
The claimant had a decision not to fund a new drug for multiple myeloma quashed. The judge overturned the decision on unreasonableness grounds, finding the meaning of ‘exceptional’ applied by the Trust meant that any case which was like another would be automatically excluded. The judge found this to be contradictory and outside of the ordinary meaning of the word ‘exceptional’. The court ordered that the policy be reviewed and that the decision be made again under a revised policy.

Papers, Reports and Books

‘Health care priority setting: principles, practice and challenges’
Mitton and Donaldson
Cost Effectiveness and Resource Allocation,
2004

Peer-reviewed journal of health resource allocation
Freely available

Resource allocation [PDF]
Paper from Ethics Network – UK

The Australian Health Care System: the potential for efficiency gains
National Health and Hospitals Reform Commission (2009)

Tragic choices and the role of administrative law
Stewart C, 2000 321 (7253) British Medical Journal 105–107.

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