30 January 2008

Don't treat the ill, say doctors

Doctors are calling for NHS treatment to be withheld from patients who claim to be unwell

Inoperable cancer patients, AIDS victims, sufferers of Alzheimer’s and victims of strokes or heart attacks should be barred from receiving medical treatment, according to doctors, with most saying the health service cannot afford to provide care to everyone.

Politeness and respect are also on the list of services that many doctors say should not be provided by an under-resourced NHS.

The findings of a survey conducted by Hello Doctor magazine sparked a fierce row last night, with campaign groups describing the recommendations from family and hospital doctors as "a bit worrying" and "questionable".

About one in 10 hospitals already denies medical services to ill patients, with restrictions most common in hospitals battling debt.

Managers defend the policies because of the higher risk of complications on the operating table for those who are ill. It is now regarded as 'best practice' to give preference to those who are healthy when allocating slots in surgery schedules. But critics believe that patients are being denied care simply to save money.

The Government announced plans last week to offer ill people cash incentives to stay at home and try to get better on their own, as part of a desperate strategy to steer Britain off a course that will otherwise see half the population suffering from illnesses by 2050.

Medical conditions cost the British taxpayer £70 billion a year. Ill people are more likely to contract other illnesses while in hospital, and to require subsequent psychotherapy as a result of traumatic encounters with rude and invasive medical staff. Department of Health officials are believed to have advised the Prime Minister that medical care should be focused on those who are still healthy, as this is likely to achieve a better return to cost.

Among the survey of 870 family and hospital doctors, almost 60 per cent said the NHS could not provide full healthcare to ill people and that some individuals should pay for services twice, once through taxes and then again when they actually needed them.

One in three said that ill patients should not be given free treatment if it were unlikely to do them good for long. Half thought that those suffering from heart disease should be denied a heart bypass, while a quarter believed that the arthritic should be denied hip replacements.

Gordon Brown promised this month that a new NHS constitution would set out people's "responsibilities" as well as their rights, a move interpreted as meaning that ill people have only themselves to blame, and should not expect to get treatment even if they have paid taxes.

Manfred Paulson, a Birmingham GP, said there were good clinical reasons for denying surgery to some patients. "The issue is: how much responsibility do people take for their health?" he said. "If a sixty-something cancer patient is going to die without intervention then that is really sad, but if he gets the chemotherapy that is denied to someone younger who could have got more years of life out of it then that is a tragedy." He said recent cases of patients, whose cancer returned after an initially succesful operation, had damaged the argument that cancer victims deserved a second chance.

However, Professor William Rogers, a surgeon who has removed many tumours from patients, said doctors could never be sure if a cancer would return, and that cancer sufferers should therefore be given the benefit of the doubt, although most doctors would expect a detailed psychological and moral assessment of a patient before admitting them for surgery.

Mary Kattons, from the Patients' Association, said it would be wrong to deny treatment because of illness. "The decision taken by the doctor has to be the best clinical one, and it has to be taken individually. It is acceptable to refuse treatment if a doctor thinks it would be in the patient's best interests to die, but it is morally wrong to deny care on any other grounds".

Apologies to: The Daily Telegraph