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Self inflicted harm—NICE in ethical self destruct mode?
  1. S Holm
  1. Correspondence to:
 Søren Holm
 Cardiff Law School, Cardiff CF10 3XJ, UK; holms{at}

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Some very bad old arguments need removing from NICE’s latest report

Let me begin this editorial by reassuring readers that the journal does not hold any deep seated grudge against the National Institute for Health and Clinical Excellence (NICE). However, because the pronouncements of NICE are of great importance to the future of health care in England, and to a lesser extent in the other nations of the United Kingdom, and because NICE is often held up as a model for other countries to follow we feel that we have to comment when these pronouncements are less than ethically excellent. And in 2005 NICE just happened to have a particularly bad year with regard to the cogency of its ethical arguments, and this flow of bad argument extended right to the end of the year.

In December 2005 NICE published a report with the title Social Value Judgments—Principles for the Development of NICE Guidance, which considered whether social background, age, or lifestyle choices should ever influence NICE guidance concerning the health care provided by the National Health Service (NHS).1 This report was endorsed by the NICE board and its guidelines are binding on all panels developing specific NICE guidance.

Here I want to focus on three areas of this report:

  • The relevance of self inflicted conditions

  • The relevance of socioeconomic status

  • The relevance of stigma

I will not comment on NICE’s methodology in coming to these conclusions, since that is the subject of a paper by John McMillan and colleagues, which is published in this issue of the journal.2

With regard to self inflicted conditions NICE has now bound itself to the following principle:


Principle 10 states that:

NICE and its advisory bodies should avoid denying care to patients with conditions that are, or may be, self …

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