Education And Debate

Lessons for health care rationing from the case of child B

BMJ 1996; 312 doi: (Published 20 January 1996) Cite this as: BMJ 1996;312:167
  1. David Price, senior research assistanta
  1. a Social Welfare Research Unit, University of Northumbria at Newcastle, Newcastle upon Tyne NE1 8ST
  • Accepted 11 October 1995

More details have emerged about the child B leukaemia case with the publication of the All England Law Report on the Appeal Court decision. At the time the view was widely held that the controversy might have been avoided if the responsible health authority had consulted the public. The law report reveals, however, that the courts adopted a moral language widely at variance with that of the patient's doctor. The courts were concerned to support a utilitarian decision procedure based on calculations of the greatest overall good; the doctor was concerned with the best interests of a sick child. The doctor-patient relationship may be damaged when public consideration transforms the issue in this way. Also, the Appeal Court supported a decision which claimed to have “weighed” opposing evaluations, but it excused the health authority from describing how that weighing took place. One of the main criticisms of the utilitarian approach, however, is that weighing of this type is extremely difficult to justify. By its ruling the court has made legal challenge on the grounds of inadequate consultation virtually impossible to substantiate.

The case of child B came to prominence almost a year ago. Widely reported as an example of explicit rationing in the new NHS, it concerned a young leukaemia sufferer who had been refused a second transplant operation by Cambridge Health Authority. The child's father challenged this decision in the High Court, where the authority was told to reconsider its refusal. The case then went to the Appeal Court, where the decision, or at least the authority's right to make such a decision in the manner it did, was upheld. Despite this victory, what caught the headline writers' attention was the High Court's ruling that in such serious cases, “the responsible authority … must do more than toll the …

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