The German Ethics Council commences its deliberations on the issue of resource allocation in healthcare

Since last year Germany, like other countries, has had a statutory requirement for cost considerations to be taken into account in certain decisions on the range of benefits provided by the public healthcare system. The German Institute for Quality and Efficiency in Health Care (IQWiG), the body responsible for the implementation of this provision, has for this purpose drawn up methodological proposals which have become the subject of critical controversy. In particular, German health economists have complained of departures from the methods of evaluation accepted within their discipline.

“In this field, highly sensitive ethical issues that call for wider-ranging discussion are dealt with in the guise of technical arguments among experts,” said the Leipzig philosopher Professor Weyma Lübbe, a member of the German Ethics Council, in her introductory presentation. In her view, as protagonists of a discipline that claimed to lack professional competence in matters of equity, the health economists should not be accorded the status, to which they aspired, of experts on rational decision-making in situations of scarcity. Instead, specialists in the disciplines of law, medicine and ethics should also be involved in the debate on health-economics-based evaluations.

Professor Lübbe drew attention to the existence of major obstacles to a serious interdisciplinary consideration of questions of resource allocation. Disputable value judgements sometimes lay deeply buried in the terminological and methodological standards applied in a given discipline, and transparency here could not easily be achieved. However, the experts could not facilitate the work of the politicians if they were unable to reach a consensus among themselves.

The ensuing discussion plainly showed that, whereas this debate was indeed affected by difficulties of comprehension at interdisciplinary level, the range of different opinions prevailing within one and the same discipline was also wide. The Ethics Council will continue to address this issue, highlighting the ethical fault lines on the basis of concrete examples of conflict. A working party has already been set up and will carry the debate forward as well as making suggestions for further consideration by the full membership of the Council.

More information can be found at www.ethikrat.org.