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

systematic and transparent. In her opinion few, if any, have succeeded. She
contended that a sophisticated method of funding distributions related to high-
cost medicines may be all for nothing if these decisions are undermined by poor
rationing and wasteful practices in a publicly funded health care delivery
system.
Wilkinson (2006) submitted to the review that there are a confusing myriad of
moral and ethical theories which can all be taken to endorse a formal principle
of equality. However, when we come to elaborate of the equality principle in
relation to health care, the theories of equity become inconsistent with each
other. Wilkinson stated that despite the confusion among equity theories, he
was less confident of a suitable high level theory emerging in relation to high-
cost pharmaceuticals than the use of intuition in particular cases.
Wilkinson (2006) reiterated Ashton’s problem that the just utility of providing
pharmaceuticals is only a small part of the publicly funded health care system.
Wilkinson discussed the comparison of priority of health care with other
priorities, giving the example of education. One person may have better access
to health care than another person’s access to education. He suggests that
utilitarianism solves the problem because a rise in the utility of one person,
without diminishing the utility of another, raises the utility of all. However, the
utilitarian principles do not work in relation to the provision of pharmaceuticals
by PHARMAC in a capped funding environment. Raising the benefits of one
person by providing expensive medicines under PHARMAC’s Community
Exceptional Circumstances policy may make the overall shares more unjust and
less equitable for the greater number.
Wilkinson suggested that PHARMAC should take consequentialist
considerations as its default position and PHARMAC focus only on the
problems caused by this consequentialism which are directly relevant. He
made this suggestion because of his assertion that every moral theory gives
some role to consequentialist considerations. A consequentialist can attach
weight to equity, give priority to the worst off or simply be a utilitarian (the best
known version of consequentialism). But he also pointed out that the sufferers
of ‘orphan diseases’ endured by very small numbers of people, are severely
disadvantaged by PHARMAC’s use of utilitarian QALY determinations. This is
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