Accountability for reasonableness

Accountability for reasonableness (A4R) is an ethical framework that describes the conditions of a fair decision-making process. It focuses on how decisions should be made and why these decisions are ethical. It was developed by Norman Daniels and James Sabin and is often applied in health policy and bioethics.

The concept of accountability for reasonableness emphasises that decision-making processes should be fair, transparent, and inclusive when making decisions about the allocation of limited healthcare resources, such as funding for medical treatments, medical services, or health programs.

Accountability for reasonableness enables the education of all stakeholders regarding fair decision-making under resource constraints. This approach navigates a middle path between proponents of "explicit" and "implicit" rationing. It fosters social learning about limitations and establishes a link between healthcare institutional decisions and broader democratic deliberative processes. As it does not mandate pre-established rationing principles like implicit approaches, it requires transparent reasoning that all parties will eventually be able to acknowledge as relevant.