Home page The right to life ... A question of love or money? Not so nice... British media report that a NICE (National Institute for Health & Clinical Excellence) committee has decided that four medicines 1  for the treatment of kidney cancer will not be available through the National Health Service on grounds of not being a cost-effective in spite of NICE finding that the medicines provide "significant gains" for survival. This is one of the clearest examples of the failure of centrally budgeted organizations being so unresponsive to those patients, who are in a minority, on the basis of economics. In constitutional terms the right to life is not something to be decided on such an arbitrary basis as the interest of the majority but rather in terms of need. We are each born with a specific genotype and depending upon the interaction of out genotype with our environment we each end up as a pheonotypic expression of our genotype. That some of us are more predisposed to specific diseases either as a result of habits or genetics has no bearing on the wish of each to enjoy as long a life as is feasible. In those cases where disease is not curable at least the provisions of medical services need to provide such people with the opportunity to live as long as they are able under tolerable circumstances. The issue is, of course, not just related to the individual but is also related to their family environment and those around them. Thus the example set for children or youth of their elderly aunts, uncles or grtandparents being taken from them as a result of discrimination on the part of a National Health Service is not a sound example of either ethical or moral behaviour in so far as an object of love is treated in what is an arbitrary manner. The ethics and morals of decision analysis on the subject of the treatment of terminal illnesses is less to do with resource allocation at the margin and more to do with the underlying preference and criteria being a serious resolution to extend support by appropriate means including modern drug therapy. Although we speak in terms of the right to life as if it were something upheld and founded in law, the more important notion is that of social expectation founded on habits where society extends support to individuals and their families where this is most needed. In the cases affected by this decision there are particularly harrowing circumstances facing many individuals and, indeed, there are other drugs refused on the same grounds related to terminal illnesses; this is not good enough in a society which considers itself to be civilised and one which to some extent extends approaches to life upholding consideration, sensitivity to need and protection. Such an approach is not something which only survives on the basis of the law but rather by the motivation of each person to defend the freedom of others to enjoy their lives to the maximum. In a civilised society, what I do and how long I live should never be the business of a political party.... The right to life extends to all, those who are terminally ill and those affected by the life concerned... The BBC cite Professor Peter Litttlejohns, a director at NICE, as stating that, "If these patients were provided on the NHS, other patients would lose out on treatments that are both clinically and cost effective.". Unfortunately, this only demonstrates that NICE and the NHS are working at cross purposes with the electorate. It is very unlikely that the people of Britain would complain if, for example, the government had spent less on buildings in the NHS and tightened their budgetss in areas related to less critical need. For example, the costs associated with shortening waiting lists for less critical procedures which is assumed by the government to be an election winner. On the other hand we know that a considerable amount of money has been wasted within the National Health Service and especially in the tiers of highly paid management. The amounts wasted on brand new buildings and less critical areas are the type of decision making which rob those in greatest need of adequate support. The annual flow of individuals diagnosed with advanced kidney cancer is somewhere around 1,700 each year and the medicines concerned seem to be able to extend life around 6 months to a year. Thus the required cashflow is something of the order of £170,000; this, in terms of the NHS budget is an irrelevance and demonstrates that the government has still not managed to allocate its excessive funding appropriately when those most in need are denied support in the way exposed by this unfortunate decision. When it comes to the ethical and moral questions related to the essential importance of love or money it is clear that NICE is working the wrong way and the National Health Service managers are letting this happen by opting for money. Of concern is that this service is now operating in an environment where far larger sums have been misallocated and waste is high and yet NICE take such callous decisions in the full expectation that they will be tolerated by ministers; something is seriously wrong.  1 : Bevacizumab, Sorafenib, Sunitinib and Temsirolimus. Posted: 7th August, 2008.