J Med Ethics 34:540-544 doi:10.1136/jme.2007.021790
  • Ethics

Public healthcare resource allocation and the Rule of Rescue

  1. R Cookson1,
  2. C McCabe2,
  3. A Tsuchiya3
  1. 1
    Department of Social Policy and Social Work, University of York, UK
  2. 2
    Academic Unit of Health Economics, Institute of Health Sciences, University of Leeds, UK
  3. 3
    Department of Economics, and School of Health and Related Research, University of Sheffield, UK
  1. Dr R Cookson, Department of Social Policy and Social Work, University of York, York YO10 5DD, UK; rc503{at}
  • Received 1 June 2007
  • Revised 30 October 2007
  • Accepted 16 November 2007


In healthcare, a tension sometimes arises between the injunction to do as much good as possible with scarce resources and the injunction to rescue identifiable individuals in immediate peril, regardless of cost (the “Rule of Rescue”). This tension can generate serious ethical and political difficulties for public policy makers faced with making explicit decisions about the public funding of controversial health technologies, such as costly new cancer drugs. In this paper we explore the appropriate role of the Rule of Rescue in public resource allocation decisions by health technology funding advisory bodies such as the National Institute for Health and Clinical Excellence. We consider practical approaches to operationalising the Rule of Rescue from Australia and the UK before examining the relevance of individual moral imperatives to public policy making. We conclude that that whilst public policy makers in a humane society should facilitate exceptional departures from a cost effectiveness norm in clinical decisions about identified individuals, it is not so obvious that they should, as a matter of national public policy, exempt any one group of unidentified individuals within society from the rules of opportunity cost at the expense of all others.


  • Funding: CMcC was partially funded by the National Institute for Health and Clinical Excellence between 2002 and 2006. RC is funded by MRC Health Services Research Special Training Fellowship G106/1145.

  • Competing interests: RC was a member of the NICE Appraisal Committee 2002–2007.