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Ethics briefings
  1. Veronica English,
  2. Rebecca Mussell,
  3. Julian Sheather,
  4. Ann Sommerville
  1. BMA Ethics Department

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    In October 2003, the High Court confirmed that where treatment cannot be provided without “undue delay” in the UK, patients have rights, under European Community law, to seek treatment in another member state and be reimbursed by the National Health Service (NHS).1 Mrs Watts was 72 and had osteoarthritis in both hips. Having been originally told she would have to wait a year for treatment, this was later reduced to several months. She enquired about treatment abroad under the established procedures but was refused because her waiting time was within the government’s target of 15 months and did not involve “undue delay”. Nevertheless, Mrs Watts arranged private treatment in France and attempted to claim reimbursement from the NHS. Although she lost her case, she succeeded in demonstrating that the NHS would indeed have to reimburse the cost of treatment involving “undue delay”.

    The court confirmed that “undue delay” is not synonymous with being outside the waiting list targets and, although relevant, waiting lists are not determinative. In assessing “undue delay” the Department of Health is required to consider all the circumstances of each case, including the patient’s medical condition, the nature and extent of the patient’s disabilities, and the degree of pain involved (R,1 para 143). In Mrs Watts’s case, Mr Justice Munby held that an “undue delay” was “very much less than [a] year” but “a period significantly (though probably not substantially) greater” than two to three months (R,1 para 174). The government was granted leave to appeal against the implications of the judgment.


    Challenges to aspects of abortion legislation have occurred in the USA and Europe. In autumn 2003, President Bush signed into law the Partial Birth Bill. This prohibits abortions where a doctor “deliberately and intentionally vaginally delivers a living fetus until, in the …

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