How does the operation of PHARMAC's 'Community Exceptional ...

Exceptional Circumstances policy. I have also drawn on literature to support the
examination of PHARMAC’s performance.
As discussed, these results show that PHARMAC stands up well to the principles
of distributive justice in relation to its role as a national drug subsidising agency.
It meets the needs of the wider population under the principle of distributive
justice described by Rawls and Sen. However, in relation to the second purpose
of PHARMAC, to manage the Community Exceptional Circumstances policy, the
results are mixed. PHARMAC does not always meet the needs of the
‘exceptional’ under the principles of distributive justice described by Rawls and
Sen and has been twice overridden by political fiat.
The Use of Intuition in Decision Making
The discussion on the test-questions presented above does not attempt to illicit
definitive answers, however PHARMAC decision makers do have to arrive at
definitive answers. If decision makers were armed to make decisions with
knowledge about clinical effectiveness, cost utility (in terms of costs and benefits)
and fairness to all, under the constraints of limited funding, this raises the
question, what part should intuition play in such determinations?
Rawls deals with the use of intuition in his discourse on reasonably held
opposing points of view (presented on p.57 of this thesis) and how these conflicts
might be managed. He suggests that this be done by reference to the two
Rawlsian principles. The first is that each person is entitled to the most extensive
basic liberty compatible with the liberty of others. The second is that where
inequalities are to be organised, that this organisation should be done by meeting
the needs of the least advantaged first. At some point intuition is needed to order
or rank these priorities and in New Zealand, particularly in distributing public
money, this has the potential for considerable political impact.
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