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

and accountability, and whether they are prepared to defend their decisions. If
decisions are open and decision makers are required to declare the reasons for
their decisions, the matters which were considered can be drawn out for anyone
who has an interest in the outcome to reflect on. This test-question also asks
for a discussion on accountability of the distribution and whether decision
makers considered all people who had an entitlement to the distribution.
Question 3: Is this distribution based on the efficiency of substantive
opportunities and on procedural fairness in defining efficiency?
This test-question seeks to find out if decision makers have considered the
utilitarian principles of the greatest benefit for the greatest number. In the
health context, the cost-utility analysis (or a variation of it) uses the international
standard measurement system of QALYs to determine substantive
opportunities. This test-question asks what do such determinations and
comparative analyses show. The second part of the test-question asks if there
is procedural fairness in the way the analysis is conceived and undertaken.
This gives decision makers an opportunity to look at how the systems work,
what information is considered relevant and what is considered irrelevant, the
consultation that took place and the systems which were used.
Question 4: Is this distribution based on information available to decision
makers about the capability of this person to do things he/she has
reason to value?
This test-question explores the capability approach to fairness and equity by
focusing on how the decisions made, or about to be made, affect people’s lives.
The question opens up the debate about comparative fairness and
consideration of the circumstances of a person’s life and how this person will be
affected by the decisions. According to Gillon (2006) groups of decision makers
do not share a perfectly matched set of values and so this discussion has the
potential to draw out, perhaps more than any of the other three test-questions,
discussion on the values which drive decisions. This question focuses on the
consequences of decisions by requiring consideration of a person’s capability.
The remedies of reducing barriers to capability may not be available to decision
makers. For example in the presence of poverty, racism or sexism these
incapacities are bought into focus and decision makers are made aware of
them.
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