Abstract
In everyday life and in health-care organizations, choices are constantly faced and ultimately made. When the choices are competing health-care resources, usually fiscal, this is called priority setting (formerly called resource allocation). A simple example would be the situation wherein enough money is left over in the budget for the neurosurgeons to buy one of two new pieces of equipment, but not both. Half the group wants one and the other half wants the other. How does the group decide? Is it based on who can give the most passionate argument or some more rational approach?
This chapter introduces the surgeon to a bioethical framework that most surgeons are not familiar with – the accountability for reasonableness – to help ensure an ethical and fair process for setting resource priorities. Its four elements are relevance (decisions are made based on good and rational reasons), transparency (the results and the decision-making process are transparent to all the stakeholders), appeals (the stakeholders can appeal the decision if they feel the need), and oversight (an external individual/group monitors the results to ensure fairness).
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Argo JL, Vick CC, Graham LA et al (2009) Elective surgical case cancellation in the veterans health administration system: identifying areas for improvement. Am J Surg 198:600–606
Chiu CH, Lee A, Chui PT (2012) Cancellation of elective operations on the day of intended surgery in a Hong Kong hospital: point prevalence and reasons. Hong Kong Med J 18:5–10
Daniels N, Sabin J (1998) The ethics of accountability in managed care reform. Health Aff (Millwood) 17:50–64
Daniels N, Sabin J (2002) Setting limits fairly: can we learn to share scarce resources? Oxford University Press, Oxford
Daniels N, Sabin JE (2008) Accountability for reasonableness: an update. BMJ 337:a1850
Garg R, Bhalotra AR, Bhadoria P et al (2009) Reasons for cancellation of cases on the day of surgery-a prospective study. Indian J Anaesth 53:35–39
Gibson JL, Martin DK, Singer PA (2005) Priority setting in hospitals: fairness, inclusiveness, and the problem of institutional power differences. Soc Sci Med 61:2355–2362
Gonzalez-Arevalo A, Gomez-Arnau JI, delaCruz FJ et al (2009) Causes for cancellation of elective surgical procedures in a Spanish general hospital. Anaesthesia 64:487–493
Gruskin S, Daniels N (2008) Process is the point: justice and human rights: priority setting and fair deliberative process. Am J Public Health 98:1573–1577
Haana V, Sethuraman K, Stephens L et al (2009) Case cancellations on the day of surgery: an investigation in an Australian paediatric hospital. ANZ J Surg 79:636–640
Harris J (1987) QALYfying the value of life. J Med Ethics 13:117–123
Harris J (1988) Life: quality, value and justice. Health Policy 10:259–266
Hasman A, Holm S (2005) Accountability for reasonableness: opening the black box of process. Health Care Anal 13:261–273
Ibrahim GM, Fallah A, Snead OC et al (2011) Ethical issues in surgical decision making concerning children with medically intractable epilepsy. Epilepsy Behav 22:154–157
Ibrahim GM, Barry BW, Fallah A et al (2012) Inequities in access to pediatric epilepsy surgery: a bioethical framework. Neurosurg Focus 32:E2
Ibrahim GM, Tymianski M, Bernstein M (2013) Priority setting in neurosurgery, as exemplified by an everyday challenge. Can J Neurol Sci 40:378–383
Kapiriri L, Norheim OF, Martin DK (2009) Fairness and accountability for reasonableness. Do the views of priority setting decision makers differ across health systems and levels of decision making? Soc Sci Med 68:766–773
Kumar R, Gandhi R (2012) Reasons for cancellation of operation on the day of intended surgery in a multidisciplinary 500 bedded hospital. J Anaesthesiol Clin Pharmacol 28:66–69
Lau HK, Chen TH, Liou CM et al (2010) Retrospective analysis of surgery postponed or cancelled in the operating room. J Clin Anesth 22:237–240
Martin DK, Singer PA, Bernstein M (2003) Access to intensive care unit beds for neurosurgery patients: a qualitative case study. J Neurol Neurosurg Psychiatry 74:1299–1303
McIntosh B, Cookson G, Jones S (2012) Cancelled surgeries and payment by results in the English national health service. J Health Serv Res Policy 17:79–86
McKneally MF, Dickens BM, Meslin EM et al (1997) Bioethics for clinicians: 13. Resource allocation. CMAJ 157:163–167
Mesmar M, Shatnawi NJ, Faori I et al (2011) Reasons for cancellation of elective operations at a major teaching referral hospital in Jordan. East Mediterr Health J 17:651–655
Neil DA, Clarke S, Oakley JG (2004) Public reporting of individual surgeon performance information: United Kingdom developments and Australian issues. Med J Aust 181:266–268
Oakley J (2009) Surgeon report cards, clinical realities, and the quality of patient care. Monash Bioeth Rev 28:21.1–21.6
Pandit JJ, Carey A (2006) Estimating the duration of common elective operations: implications for operating list management. Anaesthesia 61:768–776
Pandit JJ, Tavare A (2011) Using mean duration and variation of procedure times to plan a list of surgical operations to fit into the scheduled list time. Eur J Anaesthesiol 28:493–501
Reeleder D, Martin DK, Keresztes C et al (2005) What do hospital decision-makers in Ontario, Canada, have to say about the fairness of priority setting in their institutions? BMC Health Serv Res 5:8
Schofield WN, Rubin GL, Piza M et al (2005) Cancellation of operations on the day of intended surgery at a major Australian referral hospital. Med J Aust 182:612–615
Tung A, Dexter F, Jakubczyk S et al (2010) The limited value of sequencing cases based on their probability of cancellation. Anesth Analg 111:749–756
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Ibrahim, G.M., Bernstein, M. (2014). Priority Setting. In: Ammar, A., Bernstein, M. (eds) Neurosurgical Ethics in Practice: Value-based Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54980-9_21
Download citation
DOI: https://doi.org/10.1007/978-3-642-54980-9_21
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-54979-3
Online ISBN: 978-3-642-54980-9
eBook Packages: MedicineMedicine (R0)