Amazing: Patients 'should not expect NHS to save their life if it costs too much'

The NHS should not always attempt to save someone's life if the cost is too much, the medical regulator has ruled. The National Institute for Health and Clinical Guidelines (Nice) has ruled for the first time that saving a life cannot be justified at any cost, in a review of its ethical guidelines.

The ruling - made by the board of the controversial organisation - contradicts advice it received from its own 'Citizens Council' which offers advice from a representative sample of the general public. Nice is facing growing criticism over the number of drugs it is now rejecting which are available throughout Europe and in America. Last week, it refused to sanction four kidney cancer drugs which can double life expectancy.

It has now rejected the so-called "rule of rescue" which stipulates that people facing death should be treated regardless of the costs. The rule is based on the natural impulse to aid individuals in trouble.

In a report on "social values judgement" the regulator says: "There is a powerful human impulse, known as the 'rule of rescue', to attempt to help an identifiable person whose life is in danger, no matter how much it costs. When there are limited resources for healthcare, applying the 'rule of rescue' may mean that other people will not be able to have the care or treatment they need.

"Nice recognises that when it is making its decisions it should consider the needs of present and future patients of the NHS who are anonymous and who do not necessarily have people to argue their case on their behalf.The Institute has not therefore adopted an additional 'rule of rescue'."

The ruling contradicts the advice of Nice's Citizens Council, which said that a rule of rescue was an essential mark of a humane society. The report said that where individuals are in "desperate and exceptional circumstances" they should sometimes receive greater help than can be justified by a "purely utilitarian approach".

Doctors have also criticised the ruling. Tony Calland, chairman of the ethics committee of the British Medical Association, said: "We would be opposed to ignoring a rule of rescue when it introduces a degree of flexibility around extreme cases. So what if you waste a few pounds if you are doing your best for humanity?"

Nice defended its ruling last night saying that the Citizens Council provided useful input to its decisions but that the organisation's role was to determine how best to allocate the health service's limited resources.

Nice is facing increasing accusations that it is giving undue weight to financial considerations - rather than medical benefits - when making decisions on whether to allow drugs or other treatments on the NHS. Doctors and patients have alleged that they are treated with contempt by the organisation and that life-saving drugs are being unfairly denied.

The Daily Telegraph disclosed yesterday that Nice is preparing to offer patients advice on the medical benefits of drugs that are not available on the NHS. The disclosure is likely to anger patients who face paying tens of thousands of pounds for expensive drugs which may prolong their lives.

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MEDICAL TOURISM: HEALTH CARE FREE TRADE

Global competition in health care is allowing more patients from developed countries to travel for medical reasons to regions once characterized as "third world." Many of these "medical tourists" are not wealthy, but are seeking high quality medical care at affordable prices. To meet the growing demand, entrepreneurs are building technologically advanced facilities in India, Thailand, Latin America and elsewhere, and are hiring physicians, technicians and nurses trained to American and European standards to run them, says Devon Herrick, a senior fellow at the National Center for Policy Analysis.

Fees for treatments abroad range from one-half to as little as one-fifth the price in the United States, depending upon the destination country and type of procedure performed. For example:

Apollo Hospital in New Delhi, India, charges $4,000 for cardiac surgery, compared to about $30,000 in the United States.

A rhinoplasty (nose reconstruction) procedure that costs only $850 in India would cost $4,500 in the United States. [See the figure.]

An MRI in Brazil, Costa Rica, India, Mexico, Singapore or Thailand costs from $200 to $300, compared to more than $1,000 in the United States.

One reason why medical costs are lower abroad is that labor costs are cheaper, says Herrick:

In the United States, labor costs equal more than half of hospital operating revenue, on the average.

Yet, Indian physicians often earn only 40 percent as much, and many Indian nurses earn only one-tenth as much, as their American counterparts.

As more insured patients begin to travel abroad for low-cost medical procedures, medical tourism will result in sorely needed competition in the American health care industry, says Herrick.

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