Comprehensive guidance for doctors on care at the end of life, including difficult decisions on when to provide, withhold, or withdraw life prolonging treatment, will go out for consultation from the UK’s General Medical Council in March. The draft guidance was approved by the council at its February meeting, subject to minor amendments. The consultation will be launched in the week beginning 23 March and will end in July. The new advice takes account of the Mental Capacity Act 2005; government strategies on end of life care in England and Scotland; GMC guidance in 2007 on consent; recent research; and a Court of Appeal judgment on a legal challenge to the GMC’s 2002 guidance Withholding and Withdrawing Life-Prolonging Treatments (Burke).
[Historically] the public has remained suspicious of much experimental research which, as a result, was often done on prisoners, orphans, the mentally challenged, and other captive populations without informed consent. But with the emergence of AIDS in the early 1980s, everything changed. Highly organised groups of gay men, confronted with a mysterious life-threatening disease, aggressively advocated for greater research funding and for early inclusion in experimental trials. Their arguments were persuasive enough for the US Food and Drug Administration to revise its protocols, expediting the drug approval process. [A number of moral concerns are raised by this shift in policy] and although groups such as Abigail's Alliance have urged US courts to find a constitutional right for terminally ill patients to get access to unapproved experimental therapies, recent rulings have gone in the other direction.
Allocation of very scarce medical interventions such as organs and vaccines is a persistent ethical challenge. We evaluate eight simple allocation principles that can be classified into four categories: treating people equally, favouring the worst-off, maximising total benefits, and promoting and rewarding social usefulness. No single principle is sufficient to incorporate all morally relevant considerations and therefore individual principles must be combined into multiprinciple allocation systems. We evaluate three systems: the United Network for Organ Sharing points systems, quality-adjusted life-years, and disability-adjusted life-years. We recommend an alternative system—the complete lives system—which prioritises younger people who have not yet lived a complete life, and also incorporates prognosis, save the most lives, lottery, and instrumental value principles.
The NHS drugs watchdog has loosened the terms of approval for expensive treatments that extend life in patients with a short life expectancy. Drugs that would normally be ruled out of use on the NHS because they did not represent a cost effective use of resources are now more likely to be made available.