Evidence, ethics and inclusion: a broader base for NICE [Book Review]

Medicine, Health Care and Philosophy 14 (2):111-121 (2011)
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The National Institute for Health and Clinical Excellence (hereafter NICE) was created in 1998 to give guidance on which treatments should be provided by the British National Health Service, and to whom. So it has a crucial role as an agent of distributive justice. In this paper I argue that it is failing to adequately explain and justify its decisions in the public arena, particularly in terms of distributive justice; and that this weakens its legitimacy, to the detriment of the National Health Service as a whole. I argue that this failure arises from the fact that NICE works within the frameworks of positivist science and liberal ethics, largely to the exclusion of other perspectives. This narrowness of view prevents NICE from properly connecting with the range of moral concerns represented in the population. I argue for NICE’s deliberations to become more inclusive, both in terms of epistemology, and also in terms of ethical perspectives. And I suggest a range of perspectives that could usefully be included. Finally I offer a framework of structures, philosophies and discussion process that will enable competing perspectives to be debated fairly and productively in this process



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Prioritisation in healthcare—still muddling through.Bert Gordijn & Henk ten Have - 2011 - Medicine, Health Care and Philosophy 14 (2):109-110.

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References found in this work

An Introduction to the Principles of Morals and Legislation.Jeremy Bentham - 1780 - New York: Dover Publications. Edited by J. H. Burns & H. L. A. Hart.
Political Liberalism.J. Rawls - 1995 - Tijdschrift Voor Filosofie 57 (3):596-598.
Whose Justice? Which Rationality?Alasdair Macintyre - 1988 - Journal of Religious Ethics 16 (2):363-363.
Liberals and communitarians.Stephen Mulhall - 1992 - Cambridge, Mass., USA: Blackwell. Edited by Adam Swift.

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