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

out, there is no one set of moral imperatives on which to base value-laden
decisions to which all people would agree.
Consequently, each person answering the test-questions about the MidCentral
Health case would likely come to their own view of fairness based on their moral
and ethical beliefs. However, the test-questions do give the reader the
opportunity to reflect on the fairness of decisions on the lives of the patients and
also on the fairness of the workforce pressures on the doctors and how fair it is
to expect the doctors to treat ever increasing numbers of patients and the
stresses on them of continuing to do so. Therefore, let us consider the following
questions:
Question 1: Would the most advantaged in society accept this decision if they,
at an instant, found themselves to be the least advantaged in
society and required chemotherapy treatment for prostate,
melanoma, sarcoma or other cancers themselves?
The most advantaged in society, measured by a person’s private wealth and
position of influence in society, as a patient with one of the cancers for which
they would be denied chemotherapy treatment, has as much right to be
provided treatment in the public health service as any other person. However,
following the decision by MidCentral Health to deny them cancer treatment, the
most advantaged person would utilise their relative financial advantage by
having access to privately provided treatment. They would do this by paying
cash or through insurance cover if the public health system had refused them.
Under the conditions of this test-question, this would not be possible if at an
instant, such a person was suddenly unable to afford private treatment. They
would most likely feel greatly aggrieved at the unfairness of the DHBs decision.
There is considerable doubt about whether the MidCentral DHB decision was
taken for the reasons of clinical efficiency or for reasons to do with workload
and aspects of the doctors’ employment. If this decision was taken to save
money for the DHB to enable it to provide the greatest amount of treatment to
the greatest number, it is possible that patients who were refused treatment
would still feel maltreated. However, it is also possible that both advantaged
and disadvantaged people could come to an understanding that the greater
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