The Citizens Council provides NICE with a public perspective on overarching moral and ethical issues that NICE should take into account when producing guidance. Made up of members of the public, broadly representative of the adult UK population, the Council operates through a “citizens’ jury” style meeting, to explore and respond to a question set by NICE.
At its meeting in May 2014, the Citizens Council considered the question: “What are the societal values that need to be considered when making decisions about trade-offs between equity and efficiency?”
We started by defining our understanding of what constitutes a ‛good society’ and the societal values which underpin it. With the help of experts and case studies, the Council examined how different societal values are involved in real life decisions about the provision of care. We then looked at the differences and similarities between public health, social care and health care and also discussed any ‛special circ*mstances’ where we considered there is a need for greater emphasis on either equity or efficiency. The Council also discussed whether some key values, such as ‛dignity’ and ‛humanity’ should always be taken into account no matter which area or what the circ*mstances are.
At the end of the meeting we created a list of key societal values that we thought should be considered across public health, social care and health care.
Accountability
Collective responsibility
Dignity
Education
Fairness
Honesty
Humanity
Individual rights
Justice
Maximising total benefit/benefit for most/utilitarianism
Quality of life
Respect
Right to health and welfare for all
Safeguarding the vulnerable
Value/quality of service
We felt that these values should underpin all three areas of public health, social care and health care, not just when looking at trade-offs between equity and efficiency but as guiding principles for all of NICE’s work. However, we felt that, depending on the situation, some of these are more pertinent than others. Although we found it difficult to define how they should influence the trade-offs between equity and efficiency when making decisions, we hope we have provided insights to form the basis for further exploration by NICE.
The theme of ‛good communication’ came up throughout our discussions, in the context of how societal values are felt and experienced when the reasoning behind decisions is not effectively communicated. A lack of good communication could lead to patients or service users feeling that the decision did not match up with their expected values and not feel ‛fair’. The tension between ‛individual rights’ and wider society was also a recurrent theme and we often found it difficult to find a balance between the two, for example how the individual right to drink alcohol can create problems for society and what should constitute ‛‛the greater good’’ in that situation.
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