FOR a few brief hours last Friday, it looked as though the law courts in London were going to make a stand against the rational calculus of the health service. In the High Court, Mr Justice Laws ruled that the Cambridge Health Authority had been wrong to refuse to pay for further treatment for a 10-year-old girl suffering from acute myeloid leukaemia. Although the treatment would have been expensive, the likelihood of cure small and the probability of suffering great, Laws said that the health authority鈥檚 decision 鈥渉ad assaulted her fundamental right to life鈥�.
Just a few hours later, the status quo was restored in the Court of Appeal and the right to life recognised as not fundamental at any price. Mr Justice Laws had apparently 鈥渆ntirely failed to recognise the reality of the situation鈥�, which was that the health authority must ration its care. 鈥淒ifficult and agonising judgments have to be made as to how limited budgets can best be allocated to the maximum advantage of the maximum number of patients,鈥� ruled Sir Thomas Bingham.
Indeed, they must. There is not enough money in the world to pay for all the treatments that all the people could possibly want. But just what is the 鈥渞ationality鈥� of rationing?
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We will all have to accept that many of us will be denied care because it is too expensive. But we don鈥檛 have to accept that the rules governing that rationing are determined by the cold logic of health economics or by Bingham鈥檚 鈥渕aximum advantage of the maximum number of patients鈥�.
If they had been asked, some people would have said that the 拢75 000 needed to treat the little girl was better spent on the faintest chance of life for her than on a more definite couple of years for a 75-year-old. The 75-year-olds might even have agreed too.
New 杏吧原创 has often argued that the only way to deal with the impossibility of providing full treatment for all is to involve everyone in the painful decisions about the basis on which healthcare is to be rationed. This is surely the only way to bring into the debate some of the irrationality that makes life worth living and, at the right time, death worth accepting.