Accountability for reasonableness (A4R) is an

ethical Ethics is the philosophical study of moral phenomena. Also called moral philosophy, it investigates normative questions about what people ought to do or which behavior is morally right. Its main branches include normative ethics, applied e ...

framework that describes the conditions of a fair decision-making process. It focuses on how decisions should be made and why these decisions are ethical. It was developed by Norman Daniels and James Sabin and is often applied in

health policy Health policy can be defined as the "decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a society".World Health Organization''Health Policy'' accessed 22 March 2011(archived 5 February 2011) According ...

and

bioethics Bioethics is both a field of study and professional practice, interested in ethical issues related to health (primarily focused on the human, but also increasingly includes animal ethics), including those emerging from advances in biology, me ...

. The concept of accountability for reasonableness emphasises that decision-making processes should be fair, transparent, and inclusive when making decisions about the allocation of limited healthcare resources, such as funding for medical treatments, medical services, or health programs. Accountability for reasonableness enables the education of all stakeholders regarding fair decision-making under resource constraints. This approach navigates a middle path between proponents of "explicit" and "implicit" rationing. It fosters social learning about limitations and establishes a link between healthcare institutional decisions and broader democratic deliberative processes. As it does not mandate pre-established rationing principles like implicit approaches, it requires transparent reasoning that all parties will eventually be able to acknowledge as relevant.

Factors

The theory notes, to consider with accountability for reasonableness is to consider the following four conditions: #

Relevance Relevance is the connection between topics that makes one useful for dealing with the other. Relevance is studied in many different fields, including cognitive science, logic, and library and information science. Epistemology studies it in gener ...

: The decision-making criteria and factors considered should be relevant to the goals and values of the affected stakeholders, such as patients, healthcare providers, and the community. #

Publicity In marketing, publicity is the public visibility or awareness for any product, service, person or organization. It may also refer to the movement of information from its source to the general public, often (but not always) via the media. The sub ...

: The decision-making process should be transparent, and the reasons for the decisions made should be made publicly available. This helps ensure that the process is open to scrutiny and accountability. # Revisions and appeals: There should be a mechanism for challenging decisions and allowing for revisions or appeals. This enables stakeholders to question decisions that they believe are unjust or unreasonable. #

Enforcement Enforcement is the proper execution of the process of ensuring compliance with laws, regulations, rules, standards, and social norms. Governments attempt to effectuate successful implementation of policies by enforcing laws and regulations. En ...

: There should be an enforcement mechanism to ensure that decisions are followed through and implemented as intended.

Uses

In healthcare, accountability for reasonableness has been used to develop

guideline A guideline is a statement by which to determine a course of action. It aims to streamline particular processes according to a set routine or sound practice. They may be issued by and used by any organization (governmental or private) to make ...

s for the fair allocation of scarce resources, such as organs for transplantation, such as in consideration for

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. In education, accountability for reasonableness has been used to develop policies for the fair distribution of funding.{{Cite journal , last=Linn , first=Robert L. , date=2003-10-01 , title=Accountability: Responsibility and Reasonable Expectations , url=http://journals.sagepub.com/doi/10.3102/0013189X032007003 , journal=Educational Researcher , language=en , volume=32 , issue=7 , pages=3–13 , doi=10.3102/0013189X032007003 , issn=0013-189X, url-access=subscription

Criticism

The theory has been criticised for poorly distinguishing between relevant and irrelevant grounds for making decisions and for being unclear on explaining how the theory improves fairness in healthcare.

References

Bioethics Health policy Decision-making