Rule of rescue
The Citizens Council provides NICE with a public perspective on overarching moral and ethical issues that NICE should take into account when producing guidance. Made up of members of the public, broadly representative of the adult UK population, the Council operates through a "citizens' ju...
| Corporate Authors: | , |
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| Format: | eBook |
| Language: | English |
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London
National Institute for Health and Clinical Excellence (NICE)
2006, January 2006
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| Series: | Citizens Council reports
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| Subjects: | |
| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | The Citizens Council provides NICE with a public perspective on overarching moral and ethical issues that NICE should take into account when producing guidance. Made up of members of the public, broadly representative of the adult UK population, the Council operates through a "citizens' jury" style meeting, to explore and respond to a question set by NICE. At this three day meeting of the Council, members were asked to consider whether NICE and its advisory bodies should take account of the so-called "Rule of Rescue". Specifically, the Council was asked: Is there a preference to save the life of people in imminent danger of dying instead of: 1. improving the life of other people whose lives are not in immediate danger? or 2. Are the costs prohibitive to the NHS? To what extent does it increase the burden of costs on the NHS and society at large?8. To what extent is cost effectiveness demonstrable?9. Are there good grounds for believing it would set a precedent for other patient groups lobbying for less cost effective treatments?10. Will it avert danger to public health e.g. threat of an epidemic?11. Will people feel society's worth is diminished if it appears to be acting inhumanely by ignoring the Rule of Rescue? saving the lives of many people in the future through disease prevention programmes (such as treating high blood pressure or lowering blood cholesterol levels)? If the Council considers that NICE should ignore the Rule of Rescue - why? If the Council considers that the Rule of Rescue should be applied - when? And what limits are there? The Council felt that the term Rule of Rescue was open to different interpretations - ranging from immediate life-saving to improving the quality of life of the terminally ill - and was therefore unhelpful in answering NICE's questions. We therefore replaced the term Rule of Rescue with 'exceptional case'. When we were asked whether NICE should reject the Rule of Rescue a minority of us (6 out of 27) were opposed to any exceptional case treatment, arguing that the NHS does not have a duty to save life at any cost. It has a duty to groups as well as individuals. A majority (21 out of 27) said that it should not be rejected completely and it should be applied in certain exceptional cases. Recognising that the NHS does not have infinite resources, this majority group were able to specify when NICE should apply the Rule of Rescue and define what these limits should be. Factors NICE need to consider when developing their criteria for applying the Rule or Rescue: 1. Is the intervention required to avoid immediate loss of life?2. Is there a good chance of an increased life expectancy?3. Will it result in a significant improvement in quality of life? Are the treatment's side effects very severe and do they outweigh the good the treatment would do?4. What will be the consequences should the treatment not be received?5. What are the alternative treatments and how do they compare?6. Are future medical gains probable because of the research engendered by the treatment?7. |
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| Physical Description: | 1 PDF file (37 pages) illustrations, portrait |