Accountability for reasonableness is the idea that the reasons or rationales for important limit-setting decisions should be publicly available. In addition, these reasons must be ones that ‘fair-minded’ people can agree are relevant to pursuing appropriate patient care under necessary resource constraints … . This is our central thesis, and it needs some explanation.
By ‘fair-minded’, we do not simply mean our friends or people who just happen to agree with us. We mean people who in principle seek to cooperate with others on terms they can justify to each other. Indeed, fair-minded people accept rules of the game – or sometimes seek rule changes – that promote the game’s essential skills and the excitement their use produces.
Source: Daniels N, Sabin JE (2008) Setting Limits Fairly, Learning to Share Resources for Health. Page 44. Oxford University Press.
Two examples of the term in use:
Two central goals of health policy are to improve population health as much as possible and to distribute the improvements fairly. These goals will often conflict. Reasonable people will disagree about how to resolve these conflicts, which take the form of various unsolved rationing problems. The conflict is also illustrated by the ethical controversy that surrounds the use of cost-effectiveness analysis. Because there is no consensus on principles to resolve these disputes, a fair process is needed to assure outcomes that are perceived to be fair and reasonable. One such process, accountability for reasonableness, assures transparency, involves stakeholders in deliberating about relevant rationales, and requires that decisions be revised in light of new evidence and arguments. It has been influential in various contexts including developed countries such as Canada, the United Kingdom, New Zealand, and Sweden, and developing countries, such as Mexico …
Daniels N (2018) Reasonableness and its definition in the provision of healthcare. In Warrell DA, Cox TM, Firth JD (eds) The Oxford Textbook of Medicine. Section 2.4.2. Oxford University Press. DOI: 10.1093/med/9780199204854.003.020402. Online access to the Oxford Textbook of Medicine in low- and middle-income countries is available through the World Health Organization-led HINARI Access to Research in Health programme.
Resource allocation decisions in health care are rife with moral disagreements and a fair, deliberative process is necessary to establish the legitimacy and fairness of such decisions. To hold decision makers accountable for the reasonableness of their decisions, we have argued that the process must be public (fully transparent) about the grounds for its decisions; the decision must rest on reasons that stakeholders can agree are relevant; decisions should be revisable in light of new evidence and arguments; and there should be assurance through enforcement that these conditions (publicity, relevance, and revisability) are met. The form such procedures should take depends on the institutional context. The decisions are in any case constrained by more general considerations of justice, such as the requirement that they not be discriminatory.
Daniels N, Sabin JE (2008) Accountability for reasonableness: an update. BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a1850 (Published 09 October 2008) Cite this as: BMJ 2008;337:a1850