Making Difficult Choices

M. Oswald, D. Cox

Research output: Book/ReportCommissioned report


This guidance is for general practitioners, and particularly GPs who will have a role as commissioners in clinical commissioning groups in England. Ethics andcommissioning are big subjects. This document focuses on the following questions: When resources are limited, and when the consequences of our decisions affectthe lives of many thousands of people, how can we decide which treatments1 andservices to pick? How ought GPs and others in future clinical commissioning groups (CCGs) goabout making these difficult decisions? How can we address potential conflicts of interest that arise for GPs involved incommissioning?GPs have always made resource allocation decisions. For example, we routinely make judgements about whether a referral should be offered. Such decisions are a matter of clinical judgement, but they are also about whether the benefits justify the cost, aware as we are of the costs involved and the needs of others patients. As doctors, we are also familiar with medical ethics. The four principles of respect for autonomy, beneficence, non-maleficence and justice are helpful in clinical practice, and may be a useful way to begin thinking about ethical commissioning.When we are making decisions that will impact the health of a population, we need to justify our decisions not just on grounds of cost-effectiveness and efficacy but also in terms of justice. For example, if we change the threshold for funding cataract surgery,will this have a disproportionate effect on the elderly or people of Indian descent?We aim to offer a framework for considering questions like this, and for making andjustifying difficult choices. However, there are no widely-accepted “right answers” tothe difficult ethical questions we address in this guidance.
Original languageEnglish
Place of PublicationLondon
PublisherRoyal College of General Practitioners
Number of pages36
Publication statusPublished - Oct 2011


  • ethical commissioning guidance


Dive into the research topics of 'Making Difficult Choices'. Together they form a unique fingerprint.

Cite this