Russell Jill, Greenhalgh Trisha
Queen Mary University of London, UK
Queen Mary University of London, UK.
Health (London). 2014 Sep;18(5):441-57. doi: 10.1177/1363459313507586. Epub 2013 Nov 27.
The English National Health Service Constitution states that patients have the right to expect all decisions about access to medicines and treatments to be made 'rationally'. Rationality in health care can be framed as instrumental, institutional or practical. In this article, we present a case example from an ethnographic study of the work of 'Individual Funding Request' panels to explore how rationality is enacted and accounted for in deliberations about the rationing of health care in the National Health Service. Our rhetorical analysis highlights how an embodied, practical rationality emerges as a significant aspect of rationality in practice, but at the same time has a problematic status in formal accounts of decision-making. We suggest that being both 'human' and 'rational' is a 'delicate balance' and creates a dilemma for Individual Funding Request panels. Aristotle's notion of phronesis provides a useful lens for theorising our observation of panel deliberations, and we argue for greater attention to the value of narrative ethics in helping us understand the challenges faced by resource allocators.
英国国民医疗服务体系章程规定，患者有权期望所有关于药物获取和治疗的决策都能“合理”做出。医疗保健中的合理性可被界定为工具性、制度性或实践性的。在本文中，我们呈现了一个来自对“个人资助申请”小组工作的人种志研究的案例，以探讨在国民医疗服务体系中关于医疗保健配给的审议中，合理性是如何得以体现和解释的。我们的修辞分析突出了一种体现出来的、实践合理性如何成为实践中合理性的一个重要方面，但同时在正式的决策描述中却处于有问题的地位。我们认为，兼具“人性”与“理性”是一种“微妙的平衡”，给个人资助申请小组带来了困境。亚里士多德的实践智慧概念为我们对小组审议的观察进行理论化提供了一个有用的视角，并且我们主张更加关注叙事伦理在帮助我们理解资源分配者所面临挑战方面的价值。
