If the trebling of National Health Service expenditure since 1997 has proved anything, it is that the age old debate over resource allocation and rationing will not go away. Western medicine continues to be a victim of its own success, with each of us likely to consume ever increasing amounts of expensive medical care at the end of our lives whatever our age.1

This trend will increasingly mean that the NHS, which has a finite budget, will not be able to afford all the medical care that people want orindeedneed. Topping up NHS care with private treatment is already widespread in primary, maternity, and cancer care, as well as audiology, where patients often pay privately for new hearing aids to avoid long waits after seeing an NHS consultant.2 As inflationary pressures on medicine increase, such practice will only become more common, but a lack of …