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Getting Clear on What’s Important
In this step in the analysis we want to consider what matters or is at stake
in the decision and how relatively important these considerations are. The
values that are relevant will depend in part upon the type of problem within
the story for which we are seeking an ethically justified solution. In the case
study, exploring the question of resource-allocation criteria will focus on
notions of distributive justice, whereas for the question of who should use
the criteria and through what process, the key relevant values will concern
procedural fairness.
It is often useful to start the values analysis with what is named as important
by those involved. We have already seen that the authors of the case
implicitly believe what is substantively important including reach, pluralism,
effectiveness, impact, promoting health and raising awareness. Procedurally
what matters to the authors includes accountability, managing conflicts of
interest, ensuring best practice, and having room to challenge decisions. The
questions about evidence that are raised indicate that making decisions based
on good research is also procedurally important. In addition, the authors explicitly
name a number of values that they suggest are relevant for the wide
range of questions they raise. These include accountability, stewardship, quality,
equity, diversity and cost effectiveness and valuation.
The case study raises a number of questions under these value headings, but
it does not say what these value words mean or how they should be balanced.
While the list is useful, it is important to be clear about what is intended by
different values because different people may have different interpretations
of the same term and because within a term there may still be much content
that needs to be negotiated. For example, one could understand equity as
the idea that a resource should be distributed based on need as opposed to
other criteria (such as ability to pay, social status, etc.). Equity can thus mean
equal distribution if everyone has the same need or unequal distribution if
the needs of some are greater than the needs of others. Central to figuring
this out is how need is defined and measured. And this will depend on the
objectives the resource is meant to achieve. So when it comes to the value of
equity, what kinds of needs are relevant has to be spelled out for the values
analysis to do its work of defining the standards the solution to the issue has
to meet for it to be justified.
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