Survival of the richest

My brother raised an ethical dilemma over lunch last week. Should he give his private patients a prescription for Tamiflu (oseltamivir) if they ask for one while his NHS patients don't have that option? At the time I didn't have an answer, but Michael Jefford and colleagues provide some help in this week's BMJ (p 1075). Although the principle of distributive justice suggests he shouldn't offer something to some patients that others can't have, two other principles guiding medical ethics—beneficence (acting in the patient's best interests) and respect for autonomy—dictate that he should. “Doctors should be committed to the individual patient's interests and autonomy …