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The Future of BioethicsInternational Dialogues$
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Akira Akabayashi

Print publication date: 2014

Print ISBN-13: 9780199682676

Published to Oxford Scholarship Online: January 2014

DOI: 10.1093/acprof:oso/9780199682676.001.0001

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Primary Topic Article

Primary Topic Article

Accountability for Reasonable Priority Setting

Chapter:
(p.558) 16.1 Primary Topic Article
Source:
The Future of Bioethics
Author(s):

Norman Daniels

James Sabin

Publisher:
Oxford University Press
DOI:10.1093/acprof:oso/9780199682676.003.0076

Ethical disagreements about priorities raise questions about the legitimacy and fairness of the decisions that are made. Economic tools such as comparative effectiveness research and cost effectiveness analysis do not address important priority issues and are both insensitive to many distributive issues. The authors propose a deliberative fair process, accountability for reasonableness, to consider the ethical dimensions of priority setting decisions. The process must meet be transparent about the rationales that determine decisions, and the decisions must be revisable and the process enforceable. Such a process, we argue, not only enhances legitimacy, but produces “defeasibly” fair decisions; in some contexts, it may be easier to agree on features of a fair process than on what counts as fair. The approach has influenced decision-making in various international settings, which we review briefly.

Keywords:   Accountability for reasonableness, legitimacy, fairness, priority setting, fair process

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