Ethics and economics: the case for mental healthcare

Abstract

SummaryIn making treatment decisions, psychiatrists, like other medical professionals, must adhere to rules of ethical medical conduct. They may also need to negotiate the legalities associated with detention and treatment against a patient's wishes. The growth in guidance produced by organisations such as the National Institute for Health and Clinical Excellence has added further complexity. Practitioners are increasingly required to consider cost-effectiveness in their treatment decisions and this can appear to conflict with the principles of medical ethics. With particular reference to mental healthcare, this article attempts to answer two questions: Is economic evaluation unethical? And are the methods of economic evaluation unsound for the purpose of achieving an ethical distribution of resources?

The basics of economic evaluation in mental healthcare

“…However, society may prefer to fund a less efficient service if it believes that service will produce a more equitable distribution of resources. Thus, when undertaking an economic evaluation, which is primarily concerned with efficiency, decision makers need also to consider the equity implications of their choices (Byford 2010).…”

“…Every decision to fund a service or treat a patient in a resource-constrained health system entails a loss elsewhere. It is this loss, or opportunity cost, that is the key to understanding the economic perspective (Byford 2010).…”

Valuing knowledge of the cost and cost-effectiveness of medicines

“…5 A further concern is the perceived conflict between the role of keeper of the public purse and the basic principles of medical ethics, particularly beneficence and autonomy, which focus on the individual, as opposed to the principle of justice, which sits more comfortably with economic theory. 6 However, it is not just the clinicians we should be looking to for answers, but also the ability of policy, governing and academic bodies to successfully disseminate accessible cost and cost-effectiveness messages to those who make resource allocation decisions on a daily basis, and indeed to adequately explain the importance of such messages. The work by Singh and colleagues suggests failures in dissemination, with only 35% of the doctors surveyed stating that they had easy access within their hospitals to information about the cost of the drugs they prescribe and only 34% being aware of a system within the trust to promote cost-effective prescribing.…”