British medicine has lessons for North American medicine

BMJ 1995;310:1672 (24 June)

Letters

British medicine has lessons for North American medicine

EDITOR,--The editorial on futility by Charles Weijer and CarlElliott had a distinctly North American flavour, which willlimit its relevance to British clinicians.¹ We do not agreethat withdrawing life supporting care from a patient in a persistentvegetative state presents a dilemma; it is common sense to usthat such care is futile.

The context in which such decisions are made in North America,or in the United States at least, is very different from thatin the United Kingdom. As J Bion pointed out in the precedingeditorial, in the United Kingdom only 1-2% of the small healthcare budget is spent on intensive care whereas in the UnitedStates 15% of a much larger budget is spent on it.² In the UnitedStates "elaborate and uncomfortable therapies of dubious advantageor none to the frail elderly are deployed on a scale unimaginablein Britain."³ Doctors and . . . [Full text of this article]