How well do members of the public deal with a distributive justice problem in health care?

Abstract

Objectives: There is some debate about the appropriateness of involving the general public in decisions concerning the prioritising and rationing of health care resources. Doubt has been expressed about the public's ability to deal with these issues in a fair and rational way without taking refuge in ready-made official ideologies. This study considers the quality of discussion achieved by members of the public on this issue in terms of their ability to recognise the validity of conflicting arguments, to cope with the shifting positions created by these conflicts, and to avoid opting for simplistic ready-made solutions. It also records the participants' own perceptions of the quality of their discussion.

Methods: Four focus groups were recruited through community organisations in a suburban area of Derby, and were asked to evaluate criteria for the rationing of donor livers for transplantation, relating this to specific patient profiles. Discussions were recorded, transcribed and analysed using qualitative methods.

Results: Three groups showed an ability to work with shifting and conflicting arguments on most issues they discussed, but two of these groups showed a tendency to adopt simplistic solutions on one specific issue. The fourth group adopted a clear-cut solution to the main issues early on, and adhered to it for the rest of the discussion.

Conclusion: The overall performance of the groups suggests that rational and open public discussion can be achieved, but that participants may need support in avoiding premature adoption of simplistic solutions.