NHS Cuts Off Care To Child

Wow, what a tragic story. I'm not sure what to think. My initial reaction was that NHS should have continued to pay. Although the expense would have been enormous, it would have been insignificant compared to all the other expenses that NHS pays, so considering that this disease is so rare, what would have been the harm in paying for it? But, then when the pain was described as "intolerable", I'm not sure what to think. I'm not sure if the NHS's motivation was money or empathy. But, I still think I side with the parents, who ought to be able to make the decision for themselves about what their child's life is worth, with consultations with medical professionals of course.

Still, this is one more reminder about how unfair and tragic life can be. We should strive to make it more fair, especially for children, but we will never succeed in ridding the world of such grief.

As for your point about nationalized health care, although I don't support it, I don't see how nationalized health care made this terrible situation any worse. I could see a similar situation occurring just as easily in the US with private insurance.

I don't agree it would be just as likely with private insurance. I have never seen insurance companies taking children or adults off ventilators. It's very likely in the US this baby would still be alive. Most insurance companies have a cap on what they will pay for, after that the child usually qualifies for a state program.

Some form of rationing eventually is a necessary component of socialized medicine and I don't think US politicians have the stomach for it, which is one reason I am skeptical of nationalized health care in the US. By the way I don't have a problem with what NHS did, I'm just saying it would be handled differently in the US.

When I read the article I was reminded of the Schiavo case, where one party argued that she really had some function, etc. The autopsy proved them wrong. Also, read again how rare this condition is. And is what happens here really that different? Unless the family is already financially destitute what happens is that the insurance company will cut them off, they are driven into bankruptcy by the medical bills, and then maybe they get some help of some kind from the government. But the brutal truth is that it has nothing to do with national health care. It does happen in this country and conflating it with attempts to reform health care are bogus.

Medical ethics involves such a different discussion now than it would have in the days of our great grandparents, a time when the "heroic" measures wouldn't even have been an issue. I think the larger question here is where does technology (even though it keeps moving the line) cross the line? I think it's happening too often already. Yes, I feel sad for the parents, and while the matter being decided by the govt. is debatable, it appears to me the correct decision was made.

DaGoat - Not to bring up Bush and BDS, but Texas enacted a law that would and does turn off life support and care for "hopeless" cases.
http://en.wikinews.org/wiki/Texas_baby_removed_...

Tuesday, March 22, 2005 Sun Hudson, a six-month old Texas baby died last week when health care providers at Texas Children's Hospital in Houston, Texas removed his life support system over the objections of his mother. The action was authorized under the 1999 Futile Care Law which was signed into law by then-Gov. George W. Bush.

Under the Texas Futile Care Law, health care workers are allowed to remove expensive life support for terminally ill patients if the patient or family is unable to pay the medical bills.

The "unable to pay" claim from Wiki is false. A hospital ethics board makes a decision that any future care is "futile", no matter the cost. It is handled the same way here and in Texas.
http://www.chron.com/disp/story.mpl/politics/47...
http://medicalfutility.blogspot.com/2009/03/ida...
http://www.nationalreview.com/smithw/smith20060...
http://www.law.louisville.edu/node/1785
http://www.redorbit.com/news/health/926196/futi...
http://www.lifeethics.org/www.lifeethics.org/20...

Thanks for the great comments so far.

As to the ethics, obviously a tough choice. I did not mean to imply that current system with insurance companies would not result in similar outcomes as we know it does. However my point was IF we go to a single payer, government does it all kind of plan then it would be the one cutting off the care and in this case it does appear to be a rationing issue.

Merely making the point that conversion to single payer will not make everything fine.

I did a little "Googling" and it semms the Canadians aren't arbitrarily pulling the plug.
http://www.wesleyjsmith.com/blog/2007/12/futile...
http://www.cmaj.ca/cgi/content/full/177/10/1201
Seems care is better in Canada with a single payer system, even in thse extreme cases.

Rudi, I'm not sure how those links support your conclusion. The second link lists a shortage of ICU beds as the main reason to limit "futile care":

"The growing North American elderly population and the development of novel therapies for acute life-threatening illness has led to a large increase in the demand for intensive care unit (ICU) beds, at a rate that may soon exceed capacity.1,2 In Ontario, 2 recent studies have forecast a need for 80%–93% more ICU beds over the next 20 years."

That seems to directly support the argument that it is rationing that causes these sorts of problems. The alternative solution (create more beds and hire more nurses) isn't even mentioned in the article.

"In summary, frontline ICU physicians, nurses and respiratory therapists in Ontario have similar and well-formed opinions about how to define and resolve medically futile care and where to focus future efforts to limit the impact of futile care in the ICU. As the need for critical care beds increases, their input will be invaluable to ensure effective use of this scarce and finite resource." (emphasis added)

Compare this statement from the Canadian report to the Texas FCL:

When participants were asked to explain why patients receive inappropriate or excessive care, 3 common themes emerged (Box 1, Table 2). Most of the participants felt that futile care is often given at the insistence of the patient's family or substitute decision-maker. They said that, in some cases, these people directed care to an amazing degree, usually against the advice of the treating team, and sometimes even against the previously expressed wishes of the patient. When participants were asked why they follow the instructions of families or substitute decision-makers instead of doing what they feel is appropriate, almost all cited a lack of legal support.

This also is interesting:

Some of the participants suggested that the rationing and selective allocation of ICU resources would be ethically comparable to the selective allocation of donated organs — another finite resource. Organs are allocated on the basis of need, but also on the basis of likelihood of benefit. Patients with multiple comorbidities, poor functional status or advanced age are typically refused organs on the basis of minimal benefit.