When they told my father-in-law the hospital had done all it could, that was not, in the strictest sense, true. There was nothing the doctors could do about the large, inoperable tumor colonizing his insides. But they could have maintained his failing kidneys by putting him on dialysis. They could have continued pumping insulin to control his diabetes. He wore a pacemaker that kept his heart beating regardless of what else was happening to him, so with aggressive treatment they could — and many hospitals would — have sustained a kind of life for a while. But the hospital that treated him offers a protocol called the Liverpool Care Pathway for the Dying Patient, which was conceived in the 90s at a Liverpool cancer facility as a more humane alternative to the frantic end-of-life assault of desperate measures.
We talk, as a society, of our need to get health care costs under control. Conservatives, in particular, insist that Medicare must be reformed. Here is an enormously expensive drug that largely doesn’t work, has serious side effects and can no longer be marketed as a breast cancer therapy. Yet insurers, including Medicare, will continue to cover it. If we’re not willing to say no to a drug like Avastin, then what drug will we say no to?
A powerful arthritis drug, judged too expensive for patients in England and Wales, has been approved in Scotland. The National Institute of Clinical Excellence (Nice) provisionally ruled that Tocilizumab was too costly for NHS patients south of the border. However, the body's Scottish equivalent has recommended patients in Scotland be treated with the drug.
A distraught Newtownards father is today set to take his battle for a liver transplant for his severely ill son to the High Court. But while his legal team argue for a judicial review of a rule requiring alcoholics to be off drink for six months before being considered for a life-saving transplant, devoted dad Brian Anderson will travel to King’s Hospital in London to see his son Gareth.
A therapeutic programme hailed by ministers as a hi-tech, cost-effective solution to Britain's growing problem of depression and anxiety has been widely ignored by the NHS, leaving hundreds of thousands of people without access to treatment. Opposition politicians and charities have accused the government of creating a postcode lottery.
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.
Hospitals in north Merseyside are planning to use the anti-trespass powers used to ban “hoodies” from shopping centres to shift patients who are blocking beds. NHS Sefton board papers say that from this month patients deemed fit for discharge but who refuse “transitional” care home placements will be given 48 hours’ written notice to make their own arrangements. If a patient still refuses to leave, the hospital could seek a court order for possession of their bed. A well-placed legal source told HSJ the primary care trust’s approach would rely on trespass law, which allows owners to regulate the terms on which visitors occupy their premises.
All patients in England suffering from a disease which causes blindness are to get access to a sight-saving drug. Lucentis treats age-related macular degeneration, the leading cause of sight loss in the country.
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.
Although the number of patients seeking treatment elsewhere in the European Union is small,3 this could easily change, especially if people are faced with growing waiting lists or other forms of rationing as the new groups seek to control their budgets. British residents have had the right to obtain treatment in another EU country since 1971.4 Initially, the opportunities were limited mainly to people who fell ill when abroad or, less often, when the NHS agreed that there were good reasons for patients being treated abroad (for example, a citizen of another country resident here returning home to give birth
The refusal to move a pre-operative transsexual prisoner from a men's jail to a women's prison is a violation of her human rights, says the High Court. Deputy Judge David Elvin QC quashed Justice Secretary Jack Straw's decision to keep the 27-year-old, who cannot be identified, in a male prison.
Hospital patients in England will get the legal right to be seen privately if they face NHS delays. Hospitals have to start treating patients within 18 weeks of referral - or two weeks in the case of cancer. But ministers will now give patients a legal right to private care - or treatment at another NHS centre if so desired - if this does not happen. The Tories, who would scrap waiting time targets, said it was an "unaffordable and uncosted" pledge.
The National Institute for Health and Clinical Excellence proposes to reject a breast cancer drug despite its own rule changes on end-of-life treatments Wednesday 21 October 2009 18.11 BST A drug which can give women with advanced breast cancer extra weeks or months of life has been turned down by a government watchdog body for use in the NHS. The National Institute for Health and Clinical Excellence (Nice) says it proposes to reject Tyverb (lapatinib) in spite of changes in the rules brought in specifically to allow people at the end of their lives to have the chance of new and often expensive treatments. Tyverb is the only drug licensed for women with advanced breast cancer whose tumours test positive for a protein called HER2 and for whom Herceptin, a Nice-approved drug, is no longer working. In much of the rest of Europe, Tyverb is then given, in combination with a standard chemotherapy drug called capecitabine.