In its just-published report Taking Exception on the allocation of cancer drugs by UK Primary Care Trusts, the Rarer Cancers Forum (http://www.rarercancers.org.uk) provides further evidence of a ‘postcode lottery’ operating within the UK National Health Service. For example (p. 26), the Mid-Essex PCT has granted 96% of requests to its ‘exceptional cases panel’, while neighbouring South-West Essex PCT has granted none.
Yesterday's Daily Mail online contains an opinion piece bemoaning the decision by NICE - the UK body responsible for rationing healthcare resources - to decline funding for four new treatments for Kidney Cancer. The Mail complains:
...what does NICE offer by way of explanation? A cold, calculating statement that, while the drugs work for many of those with advanced kidney cancer, they are not 'cost-effective'.
What a clinical way to assess whether a person should be afforded precious extra months and years of life, or consigned to a 'death sentence'.
I don't want to defend NICE's decision in this particular case, but the Mail's attack on NICE's "clinical" decision-making process is clearly unjustified.
The Guardian yesterday reported the death of the man who had been so tragically shot in Antigua, with his wife, three weeks after their wedding. It began like this:
"Ben Mullany, the newlywed who was shot on honeymoon in Antigua in an attack that killed his wife, Catherine, died in hospital in Wales yesterday after his life support machine was switched off. The 31-year-old trainee physiotherapist, who had suffered a fractured skull and had a bullet lodged in the back of his head, was flown back to Britain while in a coma on Saturday. Tests carried out when his condition stabilised after the 24-hour journey established he was brain dead."
This is a familiar way of describing such happenings, even among clinical professionals. Brain death is pronounced, so the life support machine is switched off, and the patient dies. The clear implication is that brain death is not death. The machine is still keeping the patient alive, and it is switching off the machine that causes real death.
The BBC has this week published a story on co-payment in the UK's National Health Service. Sue Matthews, a Buckinghamshire woman with terminal bowel cancer, would like to top up her NHS care by paying for a £30,000 course of cetuximab - a drug which could extend her life, but which is not funded by her NHS trust. However, if she does so, she may also have to pick up the tab for her standard NHS treatment. That's because the NHS guidelines advise against allowing such co-payments: they require that a given instance of treatment be either fully privately funded, or fully publicly funded.
Should co-payments be banned?
The proposed NHS Constitution was published on Monday as a part of a consultation process to shape the future direction of the NHS. Daniel Finklestein in today’s Times suggests that the new constitution is an irresponsible document. Some of his criticisms, however, are wide of the mark.
Continue reading "Comprehensive treatment for all: The NHS Constitution" »
In Canada this week, an 84 year old man died after 9 months of treatment in an intensive care unit. He had severe brain damage and multi-organ failure, but his family sought a legal injunction to prevent doctors in the intensive care unit from withdrawing life-support. Over the course of his long intensive care stay, intensive care beds at a major trauma centre were closed so that nurses could used instead to support his care, and three doctors resigned from the hospital in protest at being required to provide what they felt was ‘unethical’ treatment.
It has been reported in the newspapers today that in many parts of the country smokers have been refused access to in-vitro-fertilisation treatment. This appears to be contrary to the national evidence-based guidelines for fertility treatment. Is this unfair?
Continue reading "Discrimination and infertility treatment" »
The New Scientist recently reviewed a variety of studies showing that many traits often supposed unique to humans are in fact shared by animals. There is evidence that apes, dolphins, songbirds, elephants, and monkeys share with humans some of the most important aspects of behaviour associated with speech; killer whales have distinct cultural groups; great apes and some monkeys have a degree of understanding of the minds of others, enabling them to deceive; chimpanzees, gorillas, and crows use tools; and there is suggestive evidence that elephants, magpies, baboons, whales, and chimpanzees demonstrate emotional behaviour, and that monkeys and rats are capable of drawing primitive moral distinctions.
Claims that animals have capacities usually thought unique to humans are controversial, and those who make them are often accused of anthropomorphising animal behaviour. Plausibly, there is often more to such accusations than concern for explanatory parsimony. As humans, we profit from using animals—for food, research, sport, and so on—in ways that we would not use other humans, and suggestions that animals are more like humans than we usually suppose place an unwelcome demand on society to rethink its ethical stance towards animals. This suggests that a clear division between humans and other species is important to us in justifying the discrepancies between what we view as ethical treatment of other humans and what we view as ethical treatment of non-human animals. Pragmatically speaking, if we humans wish to retain a privileged moral status, and if our privileged moral status is at least partly due to our being different to other animals in certain important (usually biologically-based) respects, then it is in our interests to resist attempts to draw similarities between humans and other animals.
The Royal Bank of Scotland has donated a state-of-the-art three dimensional CT scanner to an Edinburgh hospital, but with strings attached. The scanner will be available for use by NHS patients, but the Bank wants its staff to have priority access to up to 25% of the scanner's capacity.
Some politicians and academics are opposed to the gift. But would there be good grounds for rejecting it?
In Britain, the Conservative Party has challenged the government to block lesbian couples from receiving IVF treatment unless they can provide a 'male role model' for their child. This is part of a proposed amendment to the human fertilisation and embryology bill which is currently before the parliament. Such a change would be a very bad idea.
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