The values and ethical commitments of doctors engaging in macroallocation: a qualitative and evaluative analysis
Abstract Background In most socialised health systems there are formal processes that manage resource scarcity and determine the allocation of funds to health services in accordance with their priority. In this analysis, part of a larger qualitative study examining the ethical issues entailed in doc...
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| Format: | Article |
| Language: | English |
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BMC
2018-07-01
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| Series: | BMC Medical Ethics |
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| Online Access: | http://link.springer.com/article/10.1186/s12910-018-0314-1 |
| _version_ | 1818336090396819456 |
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| author | Siun Gallagher Miles Little Claire Hooker |
| author_facet | Siun Gallagher Miles Little Claire Hooker |
| author_sort | Siun Gallagher |
| collection | DOAJ |
| description | Abstract Background In most socialised health systems there are formal processes that manage resource scarcity and determine the allocation of funds to health services in accordance with their priority. In this analysis, part of a larger qualitative study examining the ethical issues entailed in doctors’ participation as technical experts in priority setting, we describe the values and ethical commitments of doctors who engage in priority setting and make an empirically derived contribution towards the identification of an ethical framework for doctors’ macroallocation work. Method We conducted semi-structured interviews with 20 doctors, each of whom participated in macroallocation at one or more levels of the Australian health system. Our sampling, data-collection, and analysis strategies were closely modelled on grounded moral analysis, an iterative empirical bioethics methodology that employs contemporaneous interchange between the ethical and empirical to support normative claims grounded in practice. Results The values held in common by the doctors in our sample related to the domains of personal ethics (‘taking responsibility’ and ‘persistence, patience, and loyalty to a cause’), justice (‘engaging in distributive justice’, ‘equity’, and ‘confidence in institutions’), and practices of argumentation (‘moderation’ and ‘data and evidence’). Applying the principles of grounded moral analysis, we identified that our participants’ ideas of the good in macroallocation and their normative insights into the practice were strongly aligned with the three levels of Paul Ricoeur’s ‘little ethics’: ‘aiming at the “good life” lived with and for others in just institutions’. Conclusions Our findings suggest new ways of understanding how doctors’ values might have procedural and substantive impacts on macroallocation, and challenge the prevailing assumption that doctors in this milieu are motivated primarily by deontological considerations. Our empirical bioethics approach enabled us to identify an ethical framework for medical work in macroallocation that was grounded in the values and ethical intuitions of doctors engaged in actions of distributive justice. The concordance between Ricoeur’s ‘little ethics’ and macroallocation practitioners’ experiences, and its embrace of mutuality, suggest that it has the potential to guide practice, support ethical reflection, and harmonise deliberative practices amongst actors in macroallocation generally. |
| first_indexed | 2024-12-13T14:33:47Z |
| format | Article |
| id | doaj.art-39867bcd66b64463af65a90c512ffefd |
| institution | Directory Open Access Journal |
| issn | 1472-6939 |
| language | English |
| last_indexed | 2024-12-13T14:33:47Z |
| publishDate | 2018-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Ethics |
| spelling | doaj.art-39867bcd66b64463af65a90c512ffefd2022-12-21T23:41:46ZengBMCBMC Medical Ethics1472-69392018-07-0119111310.1186/s12910-018-0314-1The values and ethical commitments of doctors engaging in macroallocation: a qualitative and evaluative analysisSiun Gallagher0Miles Little1Claire Hooker2Faculty of Medicine and Health, Sydney Health Ethics, Medical Foundation Building K25, University of SydneyFaculty of Medicine and Health, Sydney Health Ethics, Medical Foundation Building K25, University of SydneyFaculty of Medicine and Health, Health and Medical Humanities, Sydney Health Ethics, Medical Foundation Building K25, University of SydneyAbstract Background In most socialised health systems there are formal processes that manage resource scarcity and determine the allocation of funds to health services in accordance with their priority. In this analysis, part of a larger qualitative study examining the ethical issues entailed in doctors’ participation as technical experts in priority setting, we describe the values and ethical commitments of doctors who engage in priority setting and make an empirically derived contribution towards the identification of an ethical framework for doctors’ macroallocation work. Method We conducted semi-structured interviews with 20 doctors, each of whom participated in macroallocation at one or more levels of the Australian health system. Our sampling, data-collection, and analysis strategies were closely modelled on grounded moral analysis, an iterative empirical bioethics methodology that employs contemporaneous interchange between the ethical and empirical to support normative claims grounded in practice. Results The values held in common by the doctors in our sample related to the domains of personal ethics (‘taking responsibility’ and ‘persistence, patience, and loyalty to a cause’), justice (‘engaging in distributive justice’, ‘equity’, and ‘confidence in institutions’), and practices of argumentation (‘moderation’ and ‘data and evidence’). Applying the principles of grounded moral analysis, we identified that our participants’ ideas of the good in macroallocation and their normative insights into the practice were strongly aligned with the three levels of Paul Ricoeur’s ‘little ethics’: ‘aiming at the “good life” lived with and for others in just institutions’. Conclusions Our findings suggest new ways of understanding how doctors’ values might have procedural and substantive impacts on macroallocation, and challenge the prevailing assumption that doctors in this milieu are motivated primarily by deontological considerations. Our empirical bioethics approach enabled us to identify an ethical framework for medical work in macroallocation that was grounded in the values and ethical intuitions of doctors engaged in actions of distributive justice. The concordance between Ricoeur’s ‘little ethics’ and macroallocation practitioners’ experiences, and its embrace of mutuality, suggest that it has the potential to guide practice, support ethical reflection, and harmonise deliberative practices amongst actors in macroallocation generally.http://link.springer.com/article/10.1186/s12910-018-0314-1MacroallocationPriority settingMedical ethicsValuesPaul RicoeurGrounded moral analysis |
| spellingShingle | Siun Gallagher Miles Little Claire Hooker The values and ethical commitments of doctors engaging in macroallocation: a qualitative and evaluative analysis BMC Medical Ethics Macroallocation Priority setting Medical ethics Values Paul Ricoeur Grounded moral analysis |
| title | The values and ethical commitments of doctors engaging in macroallocation: a qualitative and evaluative analysis |
| title_full | The values and ethical commitments of doctors engaging in macroallocation: a qualitative and evaluative analysis |
| title_fullStr | The values and ethical commitments of doctors engaging in macroallocation: a qualitative and evaluative analysis |
| title_full_unstemmed | The values and ethical commitments of doctors engaging in macroallocation: a qualitative and evaluative analysis |
| title_short | The values and ethical commitments of doctors engaging in macroallocation: a qualitative and evaluative analysis |
| title_sort | values and ethical commitments of doctors engaging in macroallocation a qualitative and evaluative analysis |
| topic | Macroallocation Priority setting Medical ethics Values Paul Ricoeur Grounded moral analysis |
| url | http://link.springer.com/article/10.1186/s12910-018-0314-1 |
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