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Does the end justify the expense?


The case is described of a 70-year-old man, recently retired but fit and independent, except for haemophilia from which he had suffered all his life. However, he then had rectal bleeding for which he required treatment in hospital. To counteract the bleeding tendency he was transfused with various blood products but none was successful, and finally after an operation to determine precisely the source of the rectal bleeding, he developed peritonitis and died. Apart from the cost of hospital inpatient treatment and the blood products available from blood banks, £8500 was spent on blood products bought in the USA.

This case is discussed by a professor of haematology, a director of a regional blood transfusion service, a medical defence specialist, a consultant in geriatric medicine, and finally by a member of a university department of moral philosophy.

All the medical commentators agree that a very large sum of money was spent in treating this patient, particularly in buying supplies of commercially produced factor VIII which also carries attendant medical risks. But while this is so, it is also argued that the doctors in charge of the case could have done no other as the fatal outcome could not have been foreseen and a doctor's duty is to treat his patient to the best of his ability, even though in this case the patient was elderly and in the hospital concerned other projects had to be cancelled.

The `battle' of the treatment of the aged versus the young is touched upon by all the contributors but it is left to the moral philosopher to examine it more closely and incidentally to direct attention to the nature of the National Health Service which is neither a paternalistic system nor an insurance scheme (thought to be so by some to be a more palatable notion) but a welfare scheme in which the state forces its citizens to do things for the general good. For the moral philosopher age is irrelevant to the debate. Perhaps the consultant in geriatric medicine should have the last word: if the patient had been in the hands of a single general physician or geriatrician, he says, he would have been seen as a whole person and the arguments surrounding the case with hindsight would never have arisen.

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