In the final programme of the current series, Vivienne Parry and the ethics panel discuss a real-life case involving Richard, a man in his early fifties with colon and liver cancer. He's read about a new 'wonder drug' in the newspapers, which isn't available on the NHS, so he applies to his local primary care trust for funding.
What effect has the recent Herceptin case had on allocation of new cancer drugs? And with PCTs in financial crisis, should doctors routinely discuss the use of treatments that aren't available on the NHS?
"This programme was very interesting - my father is currently suffering from advanced colon cancer and we are facing the dilemma re: Avastin. Unfortunately, our oncologist seems to be taking the position of an accountant and is refusing to even back our case for Avastin with the PCT despite the fact that the consultant says my father would benefit from the treatment. Your programme听was particularly interesting when it was mentioned that a GP/consultant should ensure that the welfare of the patient takes precedence - this is not happening in my father's case." David
"I am a doctor who treats patients with cancer. My own view is that it is my job to advocate for my patients and to discuss all treatments that may be accessible with them.听 A problem that the programme didn't deal with was that some treatments may be available in some areas and not in others, depending on the financial health of the local hospital and primary care trusts.听 This post code prescribing is alive and well in the NHS and I think is a particularly serious ethical problem." James
"I think it could be extremely distressing to know there is an expensive drug that they could only just afford and would reduce their quality of life facing such a decision.听 I would hope that the NHS would provide counselling to enable the person to live with this" John
"I was interested to learn that it is the GPs who accept responsibility with regards to which medicines are given to patients.听 My doctor never discusses his opinions听about the drugs which he prescribes.听 I feel that it would be useful for patients if their doctors were a little more conversational with them." Anon
"My husband suffered from a brain tumour. Five years ago his consultant recommended a new drug which was not then available on the NHS. We decided to try it. The drug was in tablet form and was self administered at home. It removed the need for my husband to take up further NHS resources for the administration of chemotherapy. Our decision to pay provided the NHS with greater capacity to treat someone else.
"Nevertheless on the grounds of ethics the hospital refused to allow mixed funding and made us pay for everything: the bed he was already in when the drug was prescribed, the regular consultations he had been receiving for years and his routine scans. We even paid for the drug to be dispensed and for the hospital administration to arrange his appointments and provide the consulting room.
"This drug is now available on the NHS. Presumably the benefit it provided to my husband and many others like him added to the evidence of its efficacy and contributed to the decision to make it available on the NHS. If we had not had adequate insurance my husband may not have had three and a half more years and someone else would have been behind him in the queue. I challenged the health trust. They seemed to apply a blanket decision. They did not consider individual cases at all. Anyway, I like to think that by us paying, someone else also gained." Liz
"I was Chairman of an Ethics Committee for four years. I was concerned that there was consideration given to a drug, which the programme members mention had been so far inadequately trialled, being given to a patient by the NHS but bought by the patient. Who then would be responsible for any unexpected side effects?" Barbara
"It is not right, as was said, that the most high profile and vociferous should commandeer scarce resources at the expense of those who rarely figure in the media spotlight. During the recent Herceptin cases when PCTs capitulated in the face of media coverage and Patricia Hewitt's unhelpful intervention, I feel that they should have to say where the money was coming from." Diane
"I am concerned at the priority given to the treatment of women's illnesses compared with men's. A prime example is the new breast cancer drug being made available at the same time as a new drug for prostate cancer is NOT being made available. This of course is within the
context of women living a good few years longer than men on average. What are the ethical issues in this anti-male discrimination?" Garth
"Admin and management in the NHS get huge salaries which is not fair when people can't get drugs due to cost.听 Most people must feel the same.听 Services have got worse since these staff were put in place." Linda
"Why do these drugs cost so much?听 It is because it is all for profit.听 We should have a National Pharmaceutical Service." Kathleen
"I appreciate that somebody has to decide how to spend a limited amount of money. What is quite wrong is to describe this process as ethical. The program asserted that providing the cancer drug to one person might deny treatment to a second person.听 This is the false right wing choice which we are always being offered. A true ethical investigation would take into account that this is actually a rich country which can afford to treat both patients. But there is a choice which involves balancing the improved quality of life for patients against the rival goal of improving the quality of life for tax payers who are enabled (for example) to travel a little further by keeping down taxes." Geoff
"The government needs to find money for these drugs even if taxes are increased.听 It is criminal that people cannot get treatment due to costs." Anon
"There was much discussion of doctors' duty; but their dilemma stems not only from the case itself but from the government's failure, for political, not ethical, reasons in its duty to fund the NHS adequately." W. H. Stevenson
"The egalitarian argument used often in this programme was that of financial equality and not medical equality. The function of medical care is to give each person the best treatment for their condition. It was somewhat worrying that one view held was that the NHS provides a 'basic minimum standard of care'.
"It is unfortunate that in a country which claims to be a world leader that costs form such a large part of decision making in the NHS. Surely patient care must come first." Chris
"I feel it is unethical to produce cancer curing drugs but refuse to give the drugs on the NHS.听 If we give money to cancer research we should be allowed the drugs." Christine
"Part of the reason why the NHS is a bottomless pit that we could keep pouring money into and yet still never provides the ideal service is that as technology and science progresses we can keep more and more people alive at the margins; people who just would not have survived 30 years ago. Of course as these are the cases at the margins they are often the most expensive in terms of drugs, equipment and specialist care, they may also be the most interesting to clinicians as they are the cases that are pushing back the boundaries of science and technology.
"In a situation where it is your loved one who is a marginal case you want the NHS to do absolutely everything it possibly can to keep them alive when by doing so you maybe indirectly causing听shortages in other areas of the NHS. I feel the general public have to be more involved in the choices for priorities within the NHS so that when decisions go against them or their families they have been involved in the more overarching macro policy." Claire
