No free medical aid in Britain if treatment too expensive

August 12th, 2008 - 11:16 am ICT by IANS  

By Venkata Vemuri
London, Aug 12 (IANS) Britain’s National Health Scheme (NHS) will be asked not to save lives of patients if the cost is too high. The government’s medicines watchdog, National Institute for Clinical Excellence (NICE), has ruled for the first time that the natural impulse to go to the aid of individuals in trouble should not apply to the NHS.

The NICE report, “Social Value Judgements”, was placed on its website last month but was not publicised. The report includes advice on the treatment of smokers, drinkers and the obese. It rejects arguments that people whose illnesses are self-inflicted should get less or no treatment.

However, it says treatment may be withheld where behaviour cuts the chances of success, unless patients agree to change. The alcoholic who will not quit drinking could be denied a liver transplant.

Treatment may also be refused to elderly patients if the benefits are deemed too low or the risks too high, The Independent reported. The government is yet to react to the move.

The British Medical Association’s ethics committee chairman Tony Calland said: “We would be opposed to ignoring a rule of rescue when it introduces a degree of flexibility around extreme cases. So what if you waste a few pounds if you are doing your best for humanity?”

Peter Littlejohn, clinical and public health director at NICE, countered the argument.

“We shouldn’t have a formal rule of rescue because our general guidance took into account provision for exceptional cases. That can allow (the institute) to recommend treatment above our normal cost threshold,” he said.

The rule of rescue is described as “the powerful human impulse to help an identifiable person whose life is in danger, no matter how much it costs”. But NICE says in a report that spending too much on one patient may deny others.

The disclosure follows last week’s controversial decision by NICE to reject four new drugs for kidney cancer even though they have been shown to extend life by five to six months.

NICE has been under pressure from the drug industry to apply the so-called “rule of rescue” to such cases, setting aside costs in instances where treatment is necessary to save life.

But the institute has decided that if drugs are too expensive they should not be prescribed even if they prolong life, because the money could be better spent elsewhere. The judgement overrules advice from NICE’s own citizen’s council, which recommended two years ago that it should adopt a “rule of rescue” as an essential mark of a humane society.

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