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

in every sense, and attenuates the right by deciding what the client will or won’t
get.
The third element of distributive justice described by Malin et al. (2002) is the
idea of desert or that which one deserves. This criterion is not generally an
acceptable one on which to apportion health care because it attempts to assert
blame for the causes of disease or provide a reward for avoidance of disease.
Other factors such as genetic inheritance, family history, educational
opportunities, physical, social and political environment are not subject to what
a person can claim to deserve. Given and acquired talents are also
incomparable and defeat allocations based on this element.
The final element described by Malin et al. (2002) is utility or maximising well
being. Primarily this element rests on the assumption that the well being of
every person is equally important. Secondly it asserts that taxpayers paying
taxes are doing so on the basis of fairness and thirdly it asserts that the
distributions are efficiently applied and there is no wastage. The main problem
with distributing on the basis of utility is that the indicators for utility and
efficiency are value-laden and not easily agreed upon. Given that there is not
an unlimited resource to meet these priorities, we are taken back to the
questions of how society can agree on levels of priority while at the same time
satisfying any level of equality.
Klein and Williams (1998) debated in the literature the question of prioritisation
of scarce resources in the United Kingdom. Klein argued that the process of
priority setting is inevitably a process of debating the values of the institutions
making the decisions. Such a debate generates wide discussion about values
and context. For this reason, institutions must be equipped to hold the debate
and analyse the answers. He believed that the right process will produce
socially acceptable answers and will be arrived at by an expression of societal
values and not by any amount of cost-benefit analysis.
In the same article Williams argued the opposite position to that of Klein.
Williams (1998) stated that priority setting required clarity about objectives,
information about costs and outcomes and an ability to measure the
performance of competing interests in the priority line of choices. This is
because the decisions about priority must be framed in a context of adequate
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