Chapter 6 - Resource allocation and prioritisation
Derek is an 82 year old patient in the latter stages of bowel cancer. The treatment team feel that he has less than a year to live. A new drug has been introduced to the market which has been assessed by NICE as having the potential to give him approximately one more month of good quality life. Derek is keen to have the drug, not least because his grand-daughter Kayla is pregnant and he would dearly wish to see his new great grandchild before he dies. The treatment team approach Marc from Rowlett McGuinness LLP and Simon the hospital ethicist and tell them that, although they fully understand Derek’s reasons for wanting the drug, they feel that the cost of the drug and the small extension of life offered means that they cannot justify spending the money on this rather than on another procedure that might means a longer amount of good quality of life for someone else.
Marc tells the treatment team that, in the event of litigation, the great likelihood is that the courts would reject Derek’s claim. He notes that judges have made their reluctance to get involved plain, and that decision would have to be Wednesbury (p. 147, fn. 11) unreasonable for them to even consider getting involved. Marc also says that the decision that has been taken by the hospital does not seem to fall into that category. Indeed, given that the drug is expensive and the benefit to Derek in terms of QALYs is very small, an argument that the money would be better spent elsewhere certainly appears to be eminently reasonable. Therefore, while Derek’s reasons for wishing to have the drug are not only entirely understandable but also ones for which Marc has much sympathy, he also feels that the hospital’s decision will not be questioned by the courts. Simon struggles with this case as he also has the greatest sympathies with Derek's wish to extend his life to welcome his great-grand-child into the world. At the same time, Simon knows just as well as most other ethicists that resources are limited and tough decisions have to be taken, decisions that occasionally seem wicked or foolish or even both. He feels unable to assist as the debates for and against certain forms of healthcare allocation are conducted at a policy level, rather than at an individual patient level. Were he to be forced to give advice, he would say that Derek's aims are understandable and worthy of support, the hospital has at its disposal the means to assist him in achieving these aims and a mere argument of cost-effectiveness is inapplicable in determining whether this individual ought to be helped or not.
- C. Newdick, Who Should We Treat? Rights, Rationing and Resources in the NHS, 2nd edn (Oxford University Press, 2004) http://books.google.de/books?id=v5JtQgAACAAJ
- C. Newdick, ‘Public Health Ethics and Clinical Freedom’ (1998) 14 Journal of Contemporary Health Law and Policy 335 http://scholarship.law.edu/cgi/viewcontent.cgi?article=1337&context=jchlp
- K. Syrett, ‘Impotence or Importance? Judicial Review in an Era of Explicit NHS Rationing’ (2004) 67(2) Modern Law Review 289 http://onlinelibrary.wiley.com/doi/10.1111/j.1468-2230.2004.00487.x/abstract
- K. Veitch, ‘Juridification, Medicalisation and the Impact of EU Law: Patient Mobility and the Allocation of Scarce NHS Resources’ (2012) 20(3) Medical Law Review 362 http://medlaw.oxfordjournals.org/content/20/3/362.full.pdf+html
- J. Butler, The Ethics of Health Care Rationing (London: Cassell, 1999) http://books.google.de/books?id=cfkYQYeo_VoC
- R. Cookson and P. Dolan, ‘Principles of Justice in Health Care Rationing’ (2000) 26 Journal of Medical Ethics 523 http://jme.bmj.com/content/26/5/323.full.pdf+html
- T. Hope, J. Savulescu and J. Hendrick, Medical Law and Medical Ethics: The Core Curriculum, 2nd edn (Edinburgh: Churchill Livingstone, 2008), chapter 13 http://books.google.de/books?id=DOPfK6LvGR0C
- E. Matthews and E. Russell, Rationing Medical Care on the Basis of Age – The Moral Dimensions (Oxford: Radcliffe Publishing, 2005) http://books.google.de/books?id=WjC71zhOOycC
- I. Williams, S. Robinson and H. Dickinson, Rationing in Health Care – The Theory and Practice of Priority Setting (Bristol: The Policy Press, 2012) http://books.google.de/books?id=0IJ3WA6-234C