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

needs. This was because distinguishing between two QALYs relating to two
different people is not a valid comparison.
In his submission to the Review of High Cost Medicines (2006), Gillon criticised
the QALY system for being unable to differentiate between ‘meetable needs’
and ‘non-meetable needs’. For example, health needs that can be met by
PHARMAC’s provision of pharmaceuticals for successful treatments is an
example of meetable needs. PHARMAC also approves the subsidy on
pharmaceuticals on un-meetable needs where there is a low probability of the
treatment being successful. The moral tension presented here is the conflict
between a desire to meet very great health needs at a high cost and the desire
to meet the needs of those who will necessarily be denied treatment for lesser
health needs at lesser cost. Gillon queried whether the medical professions are
skilled at deciding when a treatment has a high or low probability of success
(i.e., the ‘let’s see what happens’ approach) which is also a valid approach.
A dilemma faced by the government, and which PHARMAC is required to
consider under the Community Exceptional Circumstances policy, is how these
requests for high cost medicines, which would benefit a patient, be managed.
Gillon argued that the production of sufficient benefit (he is careful to say
sufficient, not maximum benefit) can conflict with the just distribution of
pharmaceuticals in proportion to an individual’s need. However an adequate
theory of justice must have some concern for the greater number of people
PHARMAC is also charged with providing for. PHARMAC’s existing policy
requires a cost-utility analysis and a QALY value of at $30,000 (or less) per
QALY before PHARMAC will agree to subsidise a medicine. Gillon suggested
this is probably PHARMAC’s most important criterion. He added that other
criteria could override cost-utility analysis for example avoiding discrimination
against the elderly.
Gillon (2006) also explored the right to respect of one’s autonomy and
preferences which appeal to the utilitarian principle. The ‘I want it - so do it’
(Crisp, 2002, p. 134) phenomenon is consistent with the principle of autonomy.
However, this conflicts with the autonomy of others by reducing the
opportunities of a greater number. Gillon stated that under these conditions, if
PHARMAC refused to authorise a medication for a government subsidy, despite
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