Social-value judgements not relevant to health care
Treatment should not be denied when conditions may be self-inflicted |
Treatment should not be denied to patients with conditions that may be self-inflicted, the National Institute for Health and Clinical Excellence says in a report published last week. The report, “Social
value judgements: principles for the development of NICE guidance”,
describes the institute’s approach to incorporating social value
judgements into the processes used to develop NICE guidance. It will
be used only to help those developing NICE guidance and is not intended
as guidance for the wider NHS.
There are two reasons why NICE should not take into account whether a
condition is self-inflicted, says the report. First, it is often impossible
to decide whether someone’s condition is self-inflicted or due
to other factors, and secondly, it does not accept the principle of “deservedness” in
priority setting within the NHS. However, if self-inflicted causes of
the condition influence the clinical or cost-effectiveness of the intervention,
it may be appropriate to take this into account, it adds. A spokeswoman
for NICE gave the example of a patient with chronic obstructive pulmonary
disease who needs oxygen therapy and is a smoker. “The effect of
the smoking means that oxygen therapy is dangerous and can lead to an
explosion,” she says.
The report also emphasises that socioeconomic status, gender and sexual
orientation should not influence access to treatment. It adds that age
and race should only influence access when there is clear evidence that
these cause differences in the clinical effectiveness of an intervention.
Patient choice is also addressed: “While respect for autonomy and
individual choice are important for the NHS and its users, this should
not have the consequence of disadvantaging NHS users as a whole by having
an unacceptable opportunity cost or promoting the use of interventions
that are clinically and/or cost ineffective.” |
The
Pharmaceutical Journal
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