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‘First determine goals, then make healthcare choices’

What are the goals of healthcare? That very question must be asked more frequently before healthcare-related choices are made. This is what Martine de Vries, Professor of Normative Aspects of Medicine, advocated during her inaugural lecture on Friday, 2 November 2018.

Choices regarding funding of treatments or the allocation of healthcare funds are currently too often based on emotions, lobbying and patient proximity, De Vries contends. ‘For instance, take the medication Orkambi for the lung disease cystic fibrosis, which is funded despite a negative recommendation from the Healthcare Institute. At the end of 2017, following strong lobbying by the patients' association and others, the then minister approved remuneration of the drug. She did this without first having a fundamental discussion about the justification of the remuneration of expensive drugs of this kind, the long-term effectiveness of which has yet to be established.’

Course of life orientation for healthcare distribution

'That has to be done differently,' De Vries said. 'Choices should be based on a course-of-life vision for healthcare.’ In her inaugural lecture, De Vries highlighted a number of philosophers who could offer insights into such a vision. The basic idea is that healthcare substantially contributes to regular functioning. Illness can seriously limit the opportunities an individual would normally have enjoyed based on his/her talents and genetic background.

‘Especially in the early years of life, there is much to be gained in keeping an individual's options open. In such instances, it is justifiable to spend money on expensive, innovative treatments. However, in later years, people have already benefited from these opportunities and it may be more valuable to think about quality of life and even death, she explains. Because the healthcare budget is limited, funds need to be divided over the individual course of life, with the most rigorous efforts in earlier years.'

Read more on the website of LUMC (in Dutch)

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