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Resource allocation for solid organ transplantation : toward public and health care provider dialogue

University of British Columbia

In examining methods to facilitate debate about resource allocation for health care, this qualitative study, using constructivist methods, was designed to: 1) describe attitudes, beliefs, values and moral reasoning processes used by stakeholder groups when discussing ethical issues related to resource allocation for solid organ transplantation; and 2) describe how these groups envisioned their role, and roles of other groups, in allocation of resources. Thirty-four consumer and health care provider groups (188 participants), were purposively selected from those with a major, moderate and minor stake in the development of transplantation. Data were collected through focus group interviews, with stimulus material (a case about transplantation) used in the discussion. Three moral reasoning processes emerged as participants reasoned about ethical concerns related to resource allocation. These included "deliberative," "examined emotion," and "emotional" reasoning processes. The processes were used by all groups at different times. The process used was dependent on the context of the problem, and influenced by the participant's views about transplantation. Integrated justice and care based approaches emerged when reasoning about the ethical problems. Participants differed in applying the values and principles identified during the discussion. In particular, different theoretical perspectives of justice were used. Moral reasoning ability did not appear to be associated with education, gender or membership in a group. Three patterns of viewing transplantation were identified: "through a glass brightly" (positively), "through a glass translucently" (ambivalently), and "through a glass darkly" (negatively). These were constructed from a synthesis of values, beliefs and attitudes held about transplantation, and were dependent on factors such as personal experience, culture, ethnicity, religion, family upbringing, relationships, work context, and actual experience with transplantation. Participants supported the idea of including multiple voices in the debate about resource allocation at the macro level of the system. Consumers expressed this as an opportunity to have input into decisions, but not necessarily make them. There was support to have consumers involved in meso level decision making, including being part of boards and selection committees. Collecting data using focus groups was a way of opening up moral space for discussions about resource allocation.

Thesis/Dissertation

application/pdf

2009-04-03

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http://hdl.handle.net/2429/6802

Nursing

University of British Columbia

UBCV

DSpace