All life is equally valuable (The NHS and the disabled)

Member Name: pussycat

Product:	The NHS and the disabled
Date:	20/09/00 (79 review reads)
Rating:

Advantages: LHA may be able to respond more accurately to local needs

Disadvantages: Availability of life saving treatment is a matter of geography, no effective appeals procedure

I was shocked, but not surprised, to hear about the situation regarding Jo. As a lawyer whose second string is medical law, I am aware of many similar cases where parents have fought to compel their local health authority to provide appropriate treatment.

The difficulty is that the courts have limited powers to intervene with the decision of a local health authority unless it is improperly made. This means that each local health authority has a vast amount of discretion regarding the use of their funds.

You may remember the case of Jamie B, the little girl who was suffering from a rare and serious illness but her local authority (Cambridge, I think) decided that as the treatment that might save her life was very expensive and had a very low change of success, the expenditure was not justified as it did not represent prudent use of scarce public resources.

This case received a great deal of media coverage and the child's father decided to waive their right of anonymity to raise public awareness of the situation. He sought a judicial review of the health authority decision on his daughter's behalf. At first he was successful as the High Court quashed the health authority's decision and ordered them to reconsider. The health authority appealed against this decision to the Court of Appeal where they were successful. The Court of Appeal expressed their regret at this decision but emphasised that the role of the court in such proceedings is limited to deciding whether the correct procedure had been followed in making the decision - the substantive merits of the decision such as the potential success of the treatment and the use of public resources were not something that they can consider.

This illustrates the power that each individual health authority has to make decisions regarding patients within their region. Each HA has a different set of priorities regarding expenditure which is why you hear of situations where
by treatment which is available on the NHS is available in one region but not in another.

This, I think, represents the real flaw in the system. Leaving regional health authority's to manage their own budgets and make their own expenditure decisions means disparity of treatment for patients. The allocation of resources should be uniform throughout the country to ensure that everyone has the same access to health services.

Whatever your position on this, the basic fact is that there is not enough money to pay for all the treatment that is needed. Therefore, health authorities have to make hard decisions. In the case of Jo, the decision has been made that she should not receive the treatment that would improve the quality of her life as she does not have the average life expectancy.

But would it really be a waste of money to improve the quality of the life that she does have? Personally, I think not but its not my decision. If Jo lived in a different region, another health authority might decide differently and that, to my mind, is part of the problem here. Equally, there is no mechanism for overseeing these decisions as the courts are limited to ensuring that the decision is procedurally correct. That puts a lot of power in the hands of each health authority to make life and death decisions.

Whether the situation would be any better if the decision making process was centralised is open to debate. But it would be an improvement if there was an actual appeal procedure under which patients could challenge the actual substance of the decision not to fund their treatment rather than merely decide whether the decision was reached using the correct procedure.

My final thought is merely that surely these decisions should be made on the basis of need - which patients are in greatest need of treatment to improve the quality of their life, however long or short that may be. After all, there is no policy that people ove
r the age of 75 cannot have medical treatment because they don't have long to live. Jo is just as precious to her family and friends as any able-bodied person is to their family. It seems to me to be a poor basis for an administrative decision that a body of people can condemn her life as less valuable than any other human being.

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