Institutionalizing Responsibility in Healthcare: Epistemic Authority, Accountability and the Common Good

Contemporary healthcare depends on specialized expertise that patients, managers, payers and public decision-makers cannot independently reproduce or fully assess. This conceptual and normative article examines how scientific knowledge acquires operational authority as it is translated into recommendations, standards, technologies, procedures, reimbursement arrangements and policy decisions. It argues that scientific validity, clinical utility and institutional justification are distinct levels of judgment: a method may be scientifically valid without being clinically useful in every situation, useful without warranting routine adoption, and authorized or reimbursed without thereby becoming necessary. Responsibility must therefore follow knowledge throughout its institutional translation, preserving the visibility of evidence, uncertainty, interpretive judgment and conditions of revision while identifying who remains answerable across the decision pathway. A bounded comparative documentary analysis of routine lipid-profile testing shows how distinctions among measurement, calculation and analytical method can acquire institutional and financial significance through nomenclature and reimbursement. The article develops proportionate sufficiency as a normative criterion: the ordinary pathway must adequately meet the justified clinical need, while escalation requires identifiable additional value proportionate to its added burdens, risks and resource use. It connects this principle to lifecycle accountability and derives six operational priorities for national health policy. The common good provides the normative horizon linking appropriate care, equity, justified resource use, sustainability and trustworthy authority. Epistemic asymmetry is unavoidable in medicine; its conversion into unaccountable institutional and financial asymmetry is not.