Evidence, ethics and inclusion: a broader base for NICE

Area of Science:

• Health policy analysis
• Bioethics
• Public health decision-making

Background:

• The National Institute for Health and Clinical Excellence (NICE) plays a critical role in healthcare resource allocation within the British National Health Service.
• NICE's decisions are pivotal for distributive justice, determining treatment access and eligibility.
• Concerns exist regarding NICE's current decision-making processes and their public justification.

Purpose of the Study:

• To critically evaluate NICE's current frameworks for decision-making and justification.
• To identify limitations in NICE's reliance on positivist science and liberal ethics.
• To propose a more inclusive approach for NICE's deliberations to enhance legitimacy.

Main Methods:

• Critical analysis of NICE's operational frameworks and public justifications.
• Examination of NICE's epistemological and ethical underpinnings.
• Literature review of alternative ethical and scientific perspectives.

Main Results:

• NICE's current approach, rooted in positivist science and liberal ethics, inadequately addresses diverse moral concerns.
• This narrowness leads to insufficient explanation and justification of decisions, weakening public legitimacy.
• The exclusion of varied perspectives hinders NICE's connection with societal values.

Conclusions:

• NICE's legitimacy is undermined by its limited scope of inquiry and justification methods.
• Greater inclusivity in NICE's deliberations, incorporating diverse epistemological and ethical viewpoints, is essential.
• Implementing a framework for fair and productive debate of competing perspectives can strengthen NICE's role and public trust.