RT Article
T1 The ethics of grandfather clauses in healthcare resource allocation
JF Bioethics
VO 35
IS 2
SP 151
OP 160
A1 Wester, Gry
A1 Lu, Christine
A1 Rand, Leah Zoe Gibson
A1 Sheehan, Mark
LA English
PB Wiley-Blackwell
YR 2021
UL https://www.ixtheo.de/Record/1745992715
AB A grandfather clause is a provision whereby an old rule continues to apply to some existing situation while a new rule applies to all future cases. This paper focuses on the use of grandfather clauses in health technology appraisals (HTAs) issued by the National Institute for Health and Care Excellence (NICE) in the United Kingdom. NICE provides evidence-based guidance on healthcare technologies and public health interventions that influence resource allocation decisions in the National Health Service (NHS) and the broader public sector in England and Wales. In this context, a grandfather clause is included when NICE does not recommend treatment with a given technology. The grandfather clause provides an exemption from the general recommendation for patients who have already started treatment with the technology in question, before the publication of the NICE guidance. In this paper we first lay out the contexts in which grandfather clauses occur in NICE guidance, and then consider ethical arguments against and in support of grandfather clauses and the continuation of treatment. We argue that NICE’s current practice of automatic inclusion of a grandfather clause is ethically problematic and unfair. While the inclusion of a grandfather clause may be appropriate and justified in specific cases, we argue that inclusion of such a clause should be considered as part and parcel of the decision making process on a case by case basis, rather than adopted as the default.
K1 NICE
K1 grandfather clause
K1 healthcare resource allocation
K1 withdrawing and withholding treatment
DO 10.1111/bioe.12815