Table 4.

Ethical principles to be applied in decision making around high-cost care (HCC).

Principle	National level	Community level	Individual level
Respect for autonomy	Rights of nations to make decisions regarding the prioritization of health services in that country.	The rights of communities to be involved in the processes that affect what and how medical care will be delivered to them	The rights of individuals and their families to make decisions regarding issues that affect them
Beneficence	The HCC should provide an improvement in the quality of life in that country	The HCC should improve the quality of health and life in the community which is being provided with that service	The care that is offered has to be seen to provide value to the individual child and his/her family
Non-maleficence or “do no harm”	The provision of the particular HCC cannot be seen to endanger the delivery of other essential services	The provision of the services must not cause harm to themselves, and the removal of other services in order to afford the services must not be seen as a greater harm	Patients must be seen to benefit from the services offered. There may be a range of perceptions about what outcomes are actually acceptable
Justice	The health-care services need to provide care to as many children as possible, within the resources available. All care cannot be provided to all	There are different communities that are affected by decisions around HCC, and communities should not be disadvantaged by the provision of HCC to individuals or to other communities	Patients should have access to care on the basis of need and likelihood of benefit