Healthcare Rationing

June 12, 2013

It is a sad reality of any publically-funded heath service that there is always more that could be done if only there were sufficient finances. This short video by Medical students at the University of Leicester, raises some of the different tensions facing those who need to make decisions about the allocation of resources.


Headline Bioethics: Too NICE to Push? Ethical issues surrounding a woman’s decision for elective caesarean section

January 7, 2013

[A printable version of this Headline Bioethics Commentary is available via this link]

Author: Matthew Taylor

Clip: Women can choose caesarean birth

Date of story: 23rd November 2011

Summary of story: In November 2011, The National Institute of Health and Clinical Excellence (NICE) updated its clinical guidance to health care professionals regarding caesarean sections. This update helps ensure “every mum-to-be in England and Wales can request [a caesarean birth].” The story examines the case of Leigh East, who had concerns over a vaginal birth due to a pre-existing back injury. She was initially refused a caesarean section (CS), but was allowed the treatment after her own research persuaded her midwife to allow it. East said, “There was a great deal of pressure initially to not plan a caesarean”.

The report continues by covering how women who have had a traumatic experience with natural childbirth in the past should be treated. This includes offering counselling and, ultimately, the option for a caesarean birth if the woman is not reassured. Jenny Clery, Head of Midwifery at Whittington Hospital, said “you shouldn’t force anything on anybody, i.e. go into labour and we’ll see what happens.” The report finishes by stating the new guidelines are there to help women make an inform decision regarding mode of birth (BBC, 2011a).

Discussion of ethical issues: There are many ethical issues surrounding a woman’s choice regarding the mechanism of delivery for her unborn child. Doctors are faced with decisions requiring them to take each case individually, taking a consequentialist approach to each mode of birth, whilst also considering patient autonomy. The Changing Childbirth report (Expert Maternity Group & Cumberlege J., 1993) makes it an explicit right for a woman to be involved in decisions regarding all aspects of her pregnancy and childbirth. Read the rest of this entry »


The NHS Postcode Lottery: It Could Be You – Panorama

September 5, 2008
It Could Be You" online at the Panorama homepage

Watch "The NHS Postcode Lottery: It Could Be You" online at the BBC's Panorama homepage

In this edition of Panorama (first broadcast in the UK on BBC1 at 20.30 on the August 18th 2008), reporter Shelly Jofre investigates the “postcode lottery”, an expression that has come into usage to describe differences in the availability of medicines and other treatments dependent upon where you live, and hence under the authority of which Primary Care Trust (PCT) your provision falls. This thirty minute episode focussed on discrepancies in the guidelines for prescribing three medications: Avastin, Lucentis and Aricept, which are used in the treatment of bowel cancer, wet age-related macular degeneration (wet AMD) and Alzheimer’s Disease, respectively. What all three drugs have in common is that they are licensed as safe and effective for use in the UK, but have not been approved for unrestricted provision on the NHS by the National Institute of Clinical Excellence (NICE).

Using the stories of patients – including the author Terry Pratchett – and their doctors, The NHS Postcode Lottery explores the various agencies who have a role in deciding whether or not these drugs could or should be provided at the point of NHS care, and to whom they should go.

This is an engaging, if a little sensational, introduction to some of the ethical issues raised by current resource allocation practices within the UK healthcare system, and – insofar as it is organised around three ‘case studies’ of approximately ten minutes in length – it could form the basis for discussion of resource allocation within a GCSE science or biology lesson (see the BioethicsBytes “Bioethics in the UK Curriculum” website for details of curricula requirements in this area). This post highlights the framework into which these cases fit and, based on the information presented in this episode of Panorama, it addresses two questions: How does the ‘postcode lottery’ arise? and What are the consequences of it? It also provides a rough guide to how the programme might be used in teaching.

Read the rest of this entry »