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

This test-question did not ask if the right decision was made by the doctors. It
asks if there was any rational analysis done or evidence gathered to guide the
decision makers and who (if anyone) had the chance to have input into the
process.
Question 4: Was this decision based on information about the capacity of the
patients to do the things they have reason to value?
The decision to ration cancer chemotherapy treatment was taken without any
information about the capacity of patients to do the things they have reason to
value. This is because there was no information given to the decision makers
about the lives of the patients at all. Nor was there any attempt by decision
makers to hold a discussion with the patients who were being affected by the
decision or the consequences for the people who were denied treatment.
It is possible that some patients may have taken the option, if it was provided,
not to seek chemotherapy because they may have believed that their cancer
was incurable. They may have weighed up the options and decided that there
was reason to value a chemotherapy-free end to their lives, no matter how soon
that end might come. It is also possible that some patients, if given the option,
may have decided that they have reason to value further treatment and the
possibility of a full or partial cure.
In summary, the four test-questions give an opportunity for the chemotherapy
rationing decision to be examined in light of the elements of procedural and
outcome fairness. The documents obtained from MidCentral Health do not
describe why some cancer patients are being offered chemotherapy treatment if
they are unlikely to benefit from it. What does this tell us about all the other
cancer treatment centres in New Zealand? Are they carrying out expensive
chemotherapy treatments on patients who have little hope of recovery?
The examination of this case has highlighted the fact that the justice of
decisions about who receives treatment is not simply a matter for arrangements
which best suit the providers of health services. There is a considerable
element of moral and ethical content in the decisions to refuse some people
treatment and grant treatment to others. Such content is informed by the
principles of distributive justice.
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