6 found
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  1.  11
    Does NICE apply the rule of rescue in its approach to highly specialised technologies?Victoria Charlton - 2022 - Journal of Medical Ethics 48 (2):118-125.
    The National Institute for Health and Care Excellence, the UK’s main healthcare priority-setting body, recently reaffirmed a longstanding claim that in recommending technologies to the National Health Service it cannot apply the ‘rule of rescue’. This paper explores this claim by identifying key characteristics of the rule and establishing to what extent these are also features of NICE’s approach to evaluating ultra-orphan drugs through its highly specialised technologies programme. It argues that although NICE in all likelihood does not act because (...)
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  2.  24
    NICE and Fair? Health Technology Assessment Policy Under the UK’s National Institute for Health and Care Excellence, 1999–2018.Victoria Charlton - 2020 - Health Care Analysis 28 (3):193-227.
    The UK’s National Institute for Health and Care Excellence is responsible for conducting health technology assessment on behalf of the National Health Service. In seeking to justify its recommendations to the NHS about which technologies to fund, NICE claims to adopt two complementary ethical frameworks, one procedural—accountability for reasonableness —and one substantive—an ‘ethics of opportunity costs’ that rests primarily on the notion of allocative efficiency. This study is the first to empirically examine normative changes to NICE’s approach and to analyse (...)
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  3.  5
    The ethical canary: narrow reflective equilibrium as a source of moral justification in healthcare priority-setting.Victoria Charlton & Michael J. DiStefano - forthcoming - Journal of Medical Ethics.
    Healthcare priority-setting institutions have good reason to want to demonstrate that their decisions are morally justified—and those who contribute to and use the health service have good reason to hope for the same. However, finding a moral basis on which to evaluate healthcare priority-setting is difficult. Substantive approaches are vulnerable to reasonable disagreement about the appropriate grounds for allocating resources, while procedural approaches may be indeterminate and insufficient to ensure a just distribution. In this paper, we set out a complementary, (...)
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  4.  13
    Justice, Transparency and the Guiding Principles of the UK’s National Institute for Health and Care Excellence.Victoria Charlton - 2022 - Health Care Analysis 30 (2):115-145.
    The National Institute for Health and Care Excellence (NICE) is the UK’s primary healthcare priority-setting body, responsible for advising the National Health Service in England on which technologies to fund and which to reject. Until recently, the normative approach underlying this advice was described in a 2008 document entitled ‘Social value judgements: Principles for the development of NICE guidance’ (SVJ). In January 2020, however, NICE replaced SVJ with a new articulation of its guiding principles. Given the significant evolution of NICE’s (...)
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  5.  43
    Affordability and Non-Perfectionism in Moral Action.Benedict Rumbold, Victoria Charlton, Annette Rid, Polly Mitchell, James Wilson, Peter Littlejohns, Catherine Max & Albert Weale - 2019 - Ethical Theory and Moral Practice 22 (4):973-991.
    One rationale policy-makers sometimes give for declining to fund a service or intervention is on the grounds that it would be ‘unaffordable’, which is to say, that the total cost of providing the service or intervention for all eligible recipients would exceed the budget limit. But does the mere fact that a service or intervention is unaffordable present a reason not to fund it? Thus far, the philosophical literature has remained largely silent on this issue. However, in this article, we (...)
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  6.  3
    An empirical ethics study of the coherence of NICE technology appraisal policy and its implications for moral justification.Victoria Charlton & Michael DiStefano - 2024 - BMC Medical Ethics 25 (1):1-22.
    Background As the UK’s main healthcare priority-setter, the National Institute for Health and Care Excellence (NICE) has good reason to want to demonstrate that its decisions are morally justified. In doing so, it has tended to rely on the moral plausibility of its principle of cost-effectiveness and the assertion that it has adopted a fair procedure. But neither approach provides wholly satisfactory grounds for morally defending NICE’s decisions. In this study we adopt a complementary approach, based on the proposition that (...)
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