August 12, 2008

NHS Should Not Save Patients’ Lives If It Costs Too Much, Says Watchdog

By Jeremy Laurance

Patients cannot rely on the NHS to save their lives if the cost of doing so is too great, the Government's medicines watchdog has ruled for the first time.

The National Institute for Clinical Excellence (Nice) has said the natural impulse to go to the aid of individuals in trouble - as when vast resources are used to save a sailor lost at sea - should not apply to the NHS.

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.

Nice describes the rule of rescue as "the powerful human impulse to help an identifiable person whose life is in danger, no matter how much it costs". But it says in a report that spending too much on one patient may deny others. "When there are limited resources, applying the 'rule of rescue' may mean other people will not have the care or treatment they need," it says.

This contradicts the position of Nice's citizen's council, which concluded that individuals in "desperate and exceptional circumstances" should sometimes receive greater help than can be justified by a "purely utilitarian approach." The council, 27 members of the public chosen to be representative of lay opinion, backed the idea by 21 to six. Most agreed the NHS could not be expected to save life at any cost, but felt there were cases where, if the NHS did not intervene, society would be diminished.

The move was criticised by the British Medical Association, which said doctors had a duty to do their best for patients. Tony Calland, chairman of the ethics committee, 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?"

Originally published by By Jeremy Laurance Health Editor.

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