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dc.contributor.authorGallagher, Siun
dc.date.accessioned2019-06-27T03:46:13Z
dc.date.available2019-06-27T03:46:13Z
dc.date.issued2018-11-29
dc.identifier.urihttp://hdl.handle.net/2123/20645
dc.description.abstractBackground In most socialised health systems there are formal processes that manage resource scarcity and set priorities for the allocation of funds to health services. This thesis is an empirical bioethics study examining the ethical issues entailed in doctors’ participation as technical experts in such priority setting processes. It describes the motivations, values, and ethical commitments of doctors who engage in priority setting, their ethical experiences and perceptions, and their approach to the matter of skills for the role. The thesis makes an empirically derived contribution towards the identification of an ethical framework for doctors’ macroallocation work. Method I conducted semi-structured interviews with 20 doctors, each of whom participated in macroallocation at one or more levels of the Australian health system. My sampling, data-collection, and analysis strategies were closely modelled on grounded moral analysis, an iterative empirical bioethics methodology that employs contemporaneous interchange between the ethical and empirical to support normative claims grounded in practice. Results Applying the principles of grounded moral analysis, I identified that my participants’ ideas of the good in macroallocation and their normative insights into the practice were strongly aligned with the three levels of Paul Ricoeur’s ‘little ethics’: ‘aiming at the “good life” lived with and for others in just institutions’, and that there were deficiencies in the social process of macroallocation that impeded both doctors’ achievement of the ethical aim and the just distribution of resources. Conclusions My findings suggest new ways of understanding how doctors’ values, and rhetorical and ethical practices might have procedural and substantive impacts on macroallocation, and challenge the prevailing assumption that doctors in this milieu are motivated primarily by deontological considerations. My empirical bioethics approach enabled me to identify in Ricoeur’s ethics an ethical framework for medical work in macroallocation that was grounded in the values and ethical intuitions of doctors engaged in actions of distributive justice. The concordance between Ricoeur’s ‘little ethics’ and macroallocation practitioners’ experiences, and its embrace of mutuality, suggest that it has the potential to guide practice, support ethical reflection, and harmonise deliberative practices amongst actors in macroallocation generally.en_AU
dc.publisherUniversity of Sydneyen_AU
dc.publisherFaculty of Medicine and Healthen_AU
dc.publisherSchool of Public Healthen_AU
dc.publisherSydney Health Ethicsen_AU
dc.rightsThe author retains copyright of this thesis. It may only be used for the purposes of research and study. It must not be used for any other purposes and may not be transmitted or shared with others without prior permission.en_AU
dc.subjectmacroallocationen_AU
dc.subjectpriority settingen_AU
dc.subjectethicsen_AU
dc.subjectphysicianen_AU
dc.subjectjusticeen_AU
dc.subjectpaul ricoeuren_AU
dc.subject.otherincludes published articlesen_AU
dc.titleDoctors and the ethics of macroallocation: An empirically grounded case for Paul Ricoeur’s ‘little ethics’ as a framework for moral analysisen_AU
dc.typePhD Doctorateen_AU
dc.type.pubtypeDoctor of Philosophy Ph.D.en_AU


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