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Title: Is there a moral requirement to involve the public in strategic health care planning and organisation?
Author: Quallington, Jan
Awarding Body: Keele University
Current Institution: Keele University
Date of Award: 2010
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Abstract:
I have analysed whether or not there is a moral obligation to involve the public in the planning and organisation of health services. I have concluded that there is a moral obligation to involve the public, but that this obligation is parti-resultant and only extends to morally constructed, deliberative processes that can meet democratic conditions for political equality, effective participation and enlightened understanding. I suggest that the public democratic right to directly influence the nature and design of health services is justified by the direct impact that health provision has on each individual's wellbeing and welfare. Health care provision is aimed at restoring and maintaining the health of the population. However, In order to meet population health needs it is necessary to understand what health is. I contend that the meaning of health is highly contested and subjective, therefore, in understanding what health is it is necessary to seek different perspectives from a broad cross section of the public. I suggest that current models of decision-making in health are not sufficiently well informed by the wider public perspective of health. Deliberative models of decision-making that involve the public as equal partners have the potential to bridge this deficit. However, involving the public in decision-making does not mean that the public could, or should, necessarily have their preferences met. Autonomous choice can be embraced within a deliberative decision-making model in this context but only if the conception of autonomy is relational autonomy. That is; choice can only be morally supported when made in relation to obligations and responsibilities owed to others. Public involvement, through deliberative fora, has the potential to engage individuals who have previously been marginalised or excluded from decision making in health and has the potential to transform services in the light of new perspectives. However, this will only be realised if there is a will to transform ways of working to enable different voices to compete with existing power structures and orthodoxies. However, if final decision-making continues to reside with politicians and bureaucrats, merely informed by the public through deliberative fora, the risk is that traditional decision-makers will continue to ignore the deliberations of the public and fail to transform services to better meet different public needs. Alternatively, if public decisions are to carry weight and promote change the public must accept the responsibility and accountability for that influence, and as yet there is no system for this level of accountability to occur. I conclude that although public involvement is morally justifiable, for the public to make any reliable impact there must be significant investment in creating a climate that supports and promotes effective involvement and this may be too prohibitive to engage with, except in limited and exceptional circumstances; leaving a representative model of decision-making with in-put from the public as the compromise, default position.
Supervisor: Not available Sponsor: Not available
Qualification Name: Doctorate in Medical Ethics Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.535810  DOI: Not available
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