Relational effects should not be considered in health care priority setting
Whether a treatment can benefit a patient is often considered in criteria for health care priority setting. But we rarely consider indirect effects for the patients, or the patient’s children, friends, or partner. A recent paper published in Bioethics asks whether such relational effects could be relevant for priority setting, for example when patients suffer from dementia, where novel treatments for Alzheimer's disease could have real benefits for family and friends.
In the paper, the authors ask if, and if so how, this kind of relational effects should be taken into account when deciding how to prioritise a new treatment. According to Niklas Juth, Professor of Clinical Medical Ethics at Uppsala University and one of the authors, the case of novel treatments targeting Alzheimer's disease helps demonstrate that there are potential relational benefits, that is, benefits for those with close relations to patients.
(Image removed) Niklas Juth, Professor of Clinical Medical Ethics
“There is a simple argument for taking relational benefits into account: there is no self-evident reasons to exclude any benefits. However, when we introduce relational benefits, we might end up in a situation where we also increase the arbitrariness, which would counteract the purpose of taking them into account in the first place”, says Niklas Juth.
Despite the clear relational benefits illustrated by the case of Alzheimers’ treatments, the authors conclude that there are good arguments for not considering relational effects. There is a tension between introducing relational effects and the current needs-based approach to priority setting. In addition, considering relational effects brings more arbitrariness into the health care systems, and adds to the risk of corruption or bias from groups who can apply pressure on the system. The purpose of introducing relational effects would be to provide a more reasonable distribution of resources. However, when we decide to take effects on relations into account, we create space for arbitrariness in the system. In the end, the authors argue that the introduction of relational effects would counteract the purpose of introducing them.
Want to read the paper? Gustavsson E, Juth N, Lärfars G, Raaschou P & Sandman L, Should relational effects be considered in health care priority setting?, Bioethics, first online 21 June 2023 https://doi.org/10.1111/bioe.13189
By Josepine Fernow