It's money that matters: the financial context of ethical decision-making in modern biomedicine

摘要: While the importance of patient autonomy is widely acknowledged and discussed in bioethics literature, clinicians' autonomy, their ability to make best choices about patients' care free from outside interference, far less debated. This paper takes one form external influence over clinical decisions - cost drugs applies it a specific case, that HER2 positive breast cancer use drug Herceptin UK. Drawing on interviews with clinicians, researchers policymakers, I explore way financial shape how clinicians as individuals professional groups respond these limits seek provide treatment highest number most deserving patients they can. The point this not castigate bioethicists for misguidedly focusing but out may be so circumscribed by factors no sense speak actions stemming ethical decisions. At same time, suggest constraints create areas at margin practice which are bioethical consideration.