ABSTRACT
In this chapter, we report on the role-related conflicts experienced by doctors who participate as technical experts in deliberative macroallocation processes. Macroallocation concerns decisions about the resources available for particular kinds of health services at a population level. Participating in macroallocation as advisors to decision-makers affords doctors opportunities to advance their careers and pursue patient-related interests. We wished to understand whether–and, if so, in what form–participating doctors appreciated role-related conflict as an ethical issue. To this end, we undertook a qualitative interview study, based on the principles of the constructivist empirical bioethics methodology grounded moral analysis, in which we considered doctors’ conceptual understandings alongside ethical theory. We found that conflicts of interest and dual agency were features of macroallocation practice. Doctors did not, however, view these phenomena as ethically troubling at a personal level and constructed them not as challenges to medical professional ethics but as part of the social process of priority setting. That doctors conceptualize the problem as existing in the social, rather than internal, world suggests that procedural justice ethics frameworks may offer a viable approach to understanding and managing role-related conflicts in this setting.
