Wednesday, August 13, 2008

The Rule of Rescue in the British National Health Service

Today's Daily Telegraph (here and here) bitterly attacks NICE (the National Institute for Health and Clinical Excellence) for not adopting the rule of rescue. Here's the gist of the attack (put together from the two articles):
[NICE] has now rejected the so-called "rule of rescue" which stipulates that people facing death should be treated regardless of the costs. The rule is based on the natural impulse to aid individuals in trouble.

Surely its latest pronouncement to the effect that patients should not expect the NHS to save their lives if the treatment required to do so would be too expensive, must be designed to be so outrageously offensive as to deliberately discredit the whole principle of healthcare funded through taxation.

No? Then what on earth could its members have been thinking when they laid down a ruling that doctors and nurses were to defy the most fundamental moral inclination, not only of the medical professions, but of the human community: to do whatever is necessary to save an individual life in one's care?
The Telegraph's reaction is psychologically understandable, but logically preposterous.

I've been attacked in the same way almost every time I've discussed rationing. Physicians like to say - "with my patients, the only thing for me to consider is providing what my patients need."

My response to this kind of feel-good nonsense is often - "Doctor, that's admirable! I suppose it means that if your patient needs a heart transplant, and you are the only good match, you will donate your heart. Did I understand you right?"

As societies, we must learn how to recognize that life is a blessing, invaluable to each of us, but in economic terms life isn't priceless. In the U.S., our inability (thus far) to achieve this maturity of perspective is the major impediment to controlling our runaway health care costs.

If working people had been able to put into the bank the difference between per capita health care costs in the U.S. compared to the next costliest developed country, many of those losing their homes to foreclosure would be able to pay there mortgages. The smug moralising about NICE that we see in today's Telegraph (which is more characteristic in U.S. than U.K. political discourse) may make the moralist feel virtuous, but the end result is deeply injurious to the population.

In "Setting Limits Fairly: Learning to Share Resources for Health," Norman Daniels and I discuss these issues at much greater length (232 pages). But I think the basic point can be said in eight words: "life is a blessing, but blessings aren't priceless."

I'll discuss "Social Value Judgements: Principles for the development of NICE guidance" (the document the Telegraph is attacking) and the excellent NICE Citizens Council Report "Rule of Rescue" at greater length in the next couple of weeks.