Skip to main content

Advertisement

Log in

A Fair Range of Choice: Justifying Maximum Patient Choice in the British National Health Service

  • Original Article
  • Published:
Health Care Analysis Aims and scope Submit manuscript

Abstract

In this paper I put forward an ethical argument for the provision of extensive patient choice by the British National Health Service. I base this argument on traditional liberal rights to freedom of choice, on a welfare right to health care, and on a view of health as values-based. I argue that choice, to be ethically sustainable on this basis, must be values-based and rational. I also consider whether the British taxpayer may be persuadable with regard to the moral acceptability of patient choice, making use of Rawls’ theory of political liberalism in this context. I identify issues that present problems in terms of public acceptance of choice, and also identify a boundary issue with regard to public health choices as against individual choices.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Alazewski A, Manthorpe J (1993) Quality and the Welfare Services: A literature review. Brit J Soc Work 23:653–665

    Google Scholar 

  2. Andersson F, Lyttkens C (1999) Preferences for equity in health behind a veil of ignorance. Health Econ 8:369–378

    Article  PubMed  CAS  Google Scholar 

  3. Appleby J, Dixon J (2004) Patient choice in the NHS. Brit Med J 329:61–62

    Article  PubMed  Google Scholar 

  4. Atkinson M (2004) Figuring out body modification cultures: Interdependence and radical body modification processes. Health 8:373–386

    Article  Google Scholar 

  5. British Broadcasting Corporation (2002) Waiting lists top public concern. http://news.bbc.uk/1/hi/health/1829708 accessed 10 4 06

  6. Curtis P (2006) Safe self-harm for patients. Guardian 22 3 06. 12

  7. Dean H (2004) Human rights and welfare rights: Contextualising dependency and responsibility. In: Dean H (ed) The ethics of welfare: Human rights, dependency and responsibility (pp 7–28). Policy Press, Bristol

    Google Scholar 

  8. Department of Constitutional Affairs (2005) The mental capacity act. http://www.dca.gov.uk/menincap/legis.htm accessed 8 10 06

  9. Department of Health (2004) The NHS improvement plan: Putting people at the heart of public services. DoH, London

    Google Scholar 

  10. Dolan P, Cookson R (2000) A qualitative study of the extent to which health gain matters when choosing between different groups of patients. Health Policy 51:19–30

    Article  PubMed  CAS  Google Scholar 

  11. Ellis K (2004) Dependency, justice and the ethic of care. In: Dean H (ed) The ethics of welfare: Human rights, dependency and responsibility (pp 29–48). Policy Press, Bristol

    Google Scholar 

  12. Fairhurst E (2005) Theorising growing and being older: connecting physical health, well-being and public health. Cr Public Health 15:27–38

    Google Scholar 

  13. Fox N (1999) Beyond health: Postmodernism and embodiment. Free Association Books, London

    Google Scholar 

  14. Fulford KWM (1999) Ten principles of value-based medicine (VBM) www.cccinternational.com/iimhl/valuebasedmedicinetenprinciples.pdf accessed 12 10 05

  15. Gadamer H (1996) The enigma of health. Polity, Cambridge

    Google Scholar 

  16. Gandjour A (2001) Is subjective well-being a useful parameter for allocating resources among public interventions? Health Care Anal 9:437–447

    Article  PubMed  CAS  Google Scholar 

  17. Giddens A (1991) Modernity and self-identity. Polity, Cambridge

    Google Scholar 

  18. Goodhart D (2004) Discomfort of strangers. Guardian, 24 2 04. www.guardian.co.uk/race/story/0,11374,1154684,00.html accessed 3 6 05

  19. Hart HLA (1997) Are there any natural rights? In: Goodin E, Pettitt E (eds) Contemporary political philosophy (pp 320–327). Blackwell, Oxford

    Google Scholar 

  20. Hislop J, Arber S (2003) Understanding womens’ sleep management. Sociol Health Ill 25:815–837

    Article  Google Scholar 

  21. Hoedemakers R, Dekkers W (2003) Key concepts in health care priority setting. Health Care Anal 11:309–323

    Article  Google Scholar 

  22. Hohfeld WN (1964) Fundamental legal conceptions as applied in judicial reasoning. Yale University Press, New Haven and London

    Google Scholar 

  23. Holmes-Rovner M (2005) Likely consequences of patient choice. Health Expectations 8:1–3

    Article  PubMed  Google Scholar 

  24. Hughner R, Kleine S (2004) Views of health in the lay sector; a compilation and review of how individuals think about health. Health 8:395–422

    Article  PubMed  Google Scholar 

  25. Human Fertilisation and Embryology Authority (2005) Public says IVF benefits outweigh the risks but are concerned about the long-term consequences of treatment. HFEA, London

    Google Scholar 

  26. Hume D (1967) A treatise of human nature book 3. Fontana, London

    Google Scholar 

  27. Kerssens J, Groenewegen P (2003) Consumer choice of social health insurance in managed competition. Health Expectations 6:312–322

    Article  PubMed  Google Scholar 

  28. Lawton J (2003) Lay experiences of health and illness. Sociol Health Ill 25:23–40

    Article  Google Scholar 

  29. Lubalin J, Harris-Kojetin L (1999) What do consumers want and need to know in making health care choices. Med Care Res Rev 56(supp 1):67–102

    Article  PubMed  Google Scholar 

  30. MacDougall C (2003) Learning from the differences between ordinary and expert theories of health and physical activity. Crit Public Health 13:381–397

    Article  Google Scholar 

  31. McGauran A (2005) Consumers organisation raises questions over choice in the NHS. Brit Med J 748:330

    Google Scholar 

  32. McLachlan M (1997) Culture and health. Wiley, New York

    Google Scholar 

  33. Magee H, Davis L, Coulter A (2003) Public views on health care performance indicators and patient choice. J R Soc Med 96:338–342

    Article  PubMed  Google Scholar 

  34. Marshall TH (1950) Citizenship, social class and other essays. Cambridge University Press, Cambridge

    Google Scholar 

  35. Mill JS (1962) Utilitarianism. In: Warnock M (ed) Utilitarianism (pp. 251–321). Collins, London

    Google Scholar 

  36. Miller D (1976) Social justice. Clarendon, Oxford

    Google Scholar 

  37. Monaghan LF (2001) Looking good, feeling good: the embodied pleasures of vibrant physicality. Sociol Health Ill 23:330–356

    Article  Google Scholar 

  38. Mooney G (2005) Community claims and community capabilities. Soc Sci Med 60:247–255

    Article  PubMed  Google Scholar 

  39. National Institute for Clinical Excellence (2004) Clinical guideline 23: Depression: management of depression in primary and secondary care. NICE, London

    Google Scholar 

  40. Nozick R (1974) Anarchy State and Utopia. Basic Books, New York

    Google Scholar 

  41. O’Connor A, Drake E, Wells G, Tugwell P, Lapacis A, Elmslie T (2003) Survey of decision-making needs of Canadians faced with complex health decisions. Health Expectations 6:97–109

    Article  PubMed  Google Scholar 

  42. Pateman C (1998) Democracy, freedom and special rights. In: Boucher D, Kelly P (eds) Social justice from Hume to Walzer (pp 215–231). Routledge, London

    Google Scholar 

  43. Paton HJ (1978) The moral law: Kant’s Groundwork of the metaphysic of morals. Hutchinson, London

    Google Scholar 

  44. Plant R (1998) Why social justice? In: Boucher D, Kelly P (eds) Social justice from Hume to Walzer (pp 267–281). Routledge, London

    Google Scholar 

  45. Polakoff E, Gregory D (2002) Concepts of health: Women’s struggle for wholeness in the midst of poverty. Health Care Women Int 23:835–845

    Article  PubMed  Google Scholar 

  46. Ratcliffe J (2000) Public preferences for the allocation of donor liver grafts for transplantation. Health Econ 9:137–148

    Article  PubMed  CAS  Google Scholar 

  47. Rawls J (1993) Political liberalism. University of Columbia Press, New York

    Google Scholar 

  48. Richardson, McKie (2005) Emipricism, ethics & orthodox economic theory. Soc Sci Med 60:265–275

    Article  PubMed  Google Scholar 

  49. Seedhouse D (2005) Values based health care: The fundamentals of ethical decision-making. Wiley, New York

    Google Scholar 

  50. Sen A (1992) Inequality reexamined. Clarendon Press, Oxford

    Google Scholar 

  51. Shiell A (1997) Health outcomes are about choices and values: an economic perspective on the health outcomes movement. Health Policy 39:5–15

    Article  PubMed  CAS  Google Scholar 

  52. Stenner P, Cooper D, Skevington S (2003) Putting the Q into quality of life: The identification of subjective constructions of health-related quality of life using Q methodology. Soc Sci Med 57:2161–2172

    Article  PubMed  Google Scholar 

  53. Trappenberg M (2000) Lifestyle solidarity in the healthcare system. Health Care Anal 8:65–75

    Article  Google Scholar 

  54. Ubel P (1999) The challenge of measuring community values in ways appropriate for setting health care priorities. Kennedy Inst Ethic J 9:263–284

    Article  Google Scholar 

  55. United Nations Organisation (1948) Universal declaration of human rights. UNO, Geneva

    Google Scholar 

  56. Veatch R (1995) Abandoning informed consent. Hastings Cent Rep 25:5–12

    PubMed  CAS  Google Scholar 

  57. Welsh T, Pringle M (2001) Social capital: Trusts needs to recreate trust. Brit Med J 323:177–178

    Article  PubMed  CAS  Google Scholar 

  58. Womack S (2004) Why alarms and locks cannot take the place of neighbours. http://www.telegraph.co.uk accessed 12 04 06

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Stephen Wilmot.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wilmot, S. A Fair Range of Choice: Justifying Maximum Patient Choice in the British National Health Service. Health Care Anal 15, 59–72 (2007). https://doi.org/10.1007/s10728-006-0032-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10728-006-0032-6

Keywords

Navigation