Letter: Girl B is victim of the internal market's climate of mistrust
Your support helps us to tell the story
From reproductive rights to climate change to Big Tech, The Independent is on the ground when the story is developing. Whether it's investigating the financials of Elon Musk's pro-Trump PAC or producing our latest documentary, 'The A Word', which shines a light on the American women fighting for reproductive rights, we know how important it is to parse out the facts from the messaging.
At such a critical moment in US history, we need reporters on the ground. Your donation allows us to keep sending journalists to speak to both sides of the story.
The Independent is trusted by Americans across the entire political spectrum. And unlike many other quality news outlets, we choose not to lock Americans out of our reporting and analysis with paywalls. We believe quality journalism should be available to everyone, paid for by those who can afford it.
Your support makes all the difference.Sir: It may prove helpful to address the issues raised by the debate on treatment for the 10-year-old girl with leukemia in two stages. The first question should be: if there were no limit on resources, would aggressive treatment, on balance, be recommended for this patient? Only if the answer to that is yes, does the second question of resource availability arise.
Here we enter a very difficult debate. It is generally accepted among health authorities and public health doctors that one aim of resource allocation in the NHS should be to maximise health gain, ie, to allocate health resources to those treatments which produce the greatest increase in health per pound. However, this apparently rational, utilitarian approach has been challenged on a number of counts, including equity and possible discrimination against those with existing disabilities.
But most relevant here is the "rule of rescue", defined by the American David Hadorn as "the strong human proclivity to provide aid to identified victims of illness or accident". Presented another way, this can be seen as insurance against catastrophe - most people would hope that their contribution to the NHS, as a member of society, would ensure that if they, as an individual, needed emergency treatment costing £100,000, say after a road accident, this would not be denied on the grounds that it was not cost-effective. The debate is further complicated because treatment outcomes can only be forecast in terms of probabilities and not certainties - a fact far easier to deal with on a collective than on an individual patient basis.
This area as a whole is very difficult, with no obvious resolution. However, if society's values are that the rule of rescue is important, to ignore this in decision-making could be seen as irrational.
A national debate is needed, not only to determine what resources we as a society wish to devote to health care, but also to understand and clarify the values that should enter resource allocation decisions. The utilitarian maximisation of health gain, while an important component, may prove to be an insufficient guide.
Yours sincerely,
PENELOPE MULLEN
Health Services Management Centre, School of Public Policy
University of Birmingham
Birmingham
Join our commenting forum
Join thought-provoking conversations, follow other Independent readers and see their replies
Comments