Mari Broqvist

To accept, or not to accept, that is the question: citizen reactions to rationing

Background  The publicly financed health service in Sweden has come under increasing pressure, forcing policy makers to consider restrictions.

The meaning of severity – do citizenś views correspond to a severity framework based on ethical principles for priority setting?

The importance for governments of establishing ethical principles and criteria for priority setting in line with social values, has been emphasised. The risk of such criteria not being operationalised and instead replaced by de-contextualised priority-setting tools, has been noted. The aim of this article was to compare whether citizenś views are in line with how a criterion derived from parliamentary-decided ethical principles have been interpreted into a framework for evaluating severity levels, in resource allocation situations in Sweden. Interviews were conducted with 15 citizens and analysed by directed content analysis. The results showed that the multi-factorial aspects that participants considered as relevant for evaluating severity, were similar to those used by professionals in the Severity Framework, but added some refinements on what to consider when taking these aspects into account. Findings of similarities, such as in our study, could have the potential to strengthen the internal legitimacy among professionals, to use such a priority-setting tool, and enable politicians to communicate the justifiability of how severity is decided. The study also disclosed new aspects regarding severity, of which some are ethically disputed, implying that our results also reveal the need for ongoing ethical discussions in publicly-funded healthcare systems.

Ethical Considerations and Priority in Occupational Therapy

Working as an occupational therapist (OT) places great demands on professional knowledge, including the OT’s ethical awareness and the ability to weigh different norms and values against one another. National guidelines for priority setting are one set of norms; ethical professional codes compose another. In Sweden, OTs have not only a National Model for Transparent Prioritisation, valid for all areas of health care, but also a specific Code of Ethics to support their professional decision making through reflection and analysis.