Social contract theory and just decision making: lessons from genetic testing for the BRCA mutations.
Decisions about funding health services are crucial to controlling costs in health care insurance plans, yet they encounter serious challenges from intellectual property protection--e.g., patents--of health care services. Using Myriad Genetics' commercial genetic susceptibility test for hereditary breast cancer (BRCA testing) in the context of the Canadian health insurance system as a case study, this paper applies concepts from social contract theory to help develop more just and rational approaches to health care decision making. Specifically, Daniel's and Sabin's "accountability for reasonableness" is compared to broader notions of public consultation, demonstrating that expert assessments in specific decisions must be transparent and accountable and supplemented by public consultation.
Centre for Family Research, Faculty of Social and Political Sciences, University of Cambridge, UK.
Bryn
B
Williams-Jones
Michael M
MM
Burgess
D001943:Breast Neoplasms / Q000235:genetics; D001955:British Columbia; D002170:Canada; D003256:Community Participation; D005260:Female; D005380:Financing, Government / Q000191:economics / Q000941:ethics; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D020022:Genetic Predisposition to Disease; D033142:Genetic Services / Q000191:economics / Q000941:ethics; D005820:Genetic Testing / Q000191:economics*; D006297:Health Services Accessibility / Q000941:ethics; D006801:Humans; D007221:Industry; D007348:Insurance, Health / Q000191:economics; D009313:National Health Programs / Q000191:economics*; D010330:Patents as Topic / Q000941:ethics* / Q000331:legislation & jurisprudence; D011050:Policy Making; D017149:Private Sector; D017150:Public Sector; D040841:Resource Allocation / Q000191:economics / Q000941:ethics; D012935:Social Justice