DISTRIBUTIVE JUSTICE AND RATIONING IN THE NHS - FRAMING EFFECTS IN PRESS COVERAGE OF A CONTROVERSIAL DECISION

Despite moves towards more openness over the allocation of treatment i n the National Health Service (NHS), the public remains dependent upon the media for most of its information. This paper concerns the issue of rationing and how this was represented in newspaper articles follow ing a controversial decision by a health authority to withhold a parti cular treatment from a 10-year old girl suffering from leukaemia. Rele vant articles on this issue from a cross-section of newspapers were su bjected to analysis using the method of Grounded Theory. Three major t hemes emerged: (i) the criteria for allocating treatment; (ii) who sho uld make the decisions; and (iii) the consequences of transparency in the context of the current 'market' ethos in the NHS. Views diver ed d epending upon how the issue was framed, with some taking a patient-cen tred perspective and others emphasizing the dilemma of priority-settin g. Some welcomed greater transparency, but for others this underlined the incompatibility of two distributive domains, namely, the delivery of care and compassion vs. the more 'rational' cost-benefit calculatio ns associated with the economic domain. Overall, the tone of debate wa s at a fairly superficial level with little consensus about how to beg in to address these issues. (C) 1997 by John Wiley & Sons, Ltd.