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

good may be served by their not receiving treatment for their condition for which
the benefit is uncertain or indeed unlikely.
However, if this action was taken to put pressure on the DHB (and ultimately the
government) to increase the wages of the doctors involved, this reason would
fail Rawls’ fairness test. The reason it would fail the test is that any decision to
ration treatment based on pressure to increase salaries does not avoid bias,
take note of the interests and concerns of others, or avoid the influence of
vested interests or the personal priorities of the doctors.
Oncologists with more than 4 years experience can expect to earn up to
$240,000 annually and oncologists with more than 10 years experience average
up to $310,000 per year. 17 The least well off in society may feel it an unfair
decision to refuse them treatment, if the refusal was based on a campaign to
increase salaries beyond these salary ranges. These questions were never put
to the patients during the decision making process, so the range of answers
from them will never be known.
Question 2: Was this decision to deny some people chemotherapy treatment
arranged so that it is attached to positions and offices which are
open and accountable to all?
The OIA request demonstrated that the decision was made by people within the
DHB who did not consult the public before making the decision. Neither did the
doctors consider any documentary evidence, published journal articles, peer
reviewed research papers or public policy material to guide their decision. The
OIA request information stated that the doctors based the decision on their
clinical experience.
The Chief Science Advisor, Professor Peter Gluckman advises against the
approach of making policy decisions without the benefit of evidence or without
putting in place a monitoring system to gauge the effectiveness of the policy.
Professor Gluckman (2011) commented that “many policies developed in
isolation from the available evidence, or initiated and continued in the absence
of monitoring and formal evaluation of impact and effectiveness may well be
ineffective in meeting their primary or secondary policy objectives” (Gluckman,
2011).
17 See http://currentcancer.com/oncologists-salary-range.html for salary ranges of a New Zealand Oncologist.
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