20 January 2011

Local oppressors: so much better

The Mail led the way in highlighting how NICE, the Government’s drugs rationing body, was denying life-prolonging treatments to cancer patients purely on the grounds of cost. ... Of course, the NHS does not have unlimited funds, and on occasion patients must be told No – however heartbreaking this may be. But these decisions must be taken by doctors who know the person best. Not by bureaucrats sat in regional offices. (‘One more injustice’, editorial page, Daily Mail, 21 November 2010. )

And how is that supposed to help? Instead of an explicit universal prohibition, a subjective decision will be made by ‘your’ doctor who has his own reasons for knowing how much he will enjoy depriving you of something you will really suffer from not having. He may know that you are middle-class, send your children to non-state schools, have a high IQ, and so on. Just how much each individual doctor hates a particular characteristic is variable, but I do not see any advantage in that.

Better to have a blanket prohibition based on some objective criterion, however arbitrary, and to have to pay to get the refused treatment if you do not qualify. You are over the age of 57, or you are over 6 foot tall? Then you do not qualify for the free medication, and can only get it by paying for it. Actually it is quite likely that many of those refused the treatment would be willing and able to do so, as they would be more likely to fall into the category of bourgeois over-achievers or intellectuals, who are more likely to be refused things than those who are regarded as acceptably down and out.

There is certainly no advantage to the individual in having decisions about himself made by members of the local community who think they know him well, compared to having them made at a distance by bureaucrats. It is not that the latter are likely to be well-intentioned towards him, but that the damage which is intended can be more accurately directed by members of the local community, including one’s ‘own’ doctor.

In my own case, I was prevented from taking advantage of the legal possibility of taking exams (including degrees) before the ‘normal’ age, by the hostility of the local community, including some relatives, who knew too much about my father and myself.

The most I ask of society is that it should express the will of the majority in a blind and imperfect way. That would at least give one a sporting chance of survival. (Celia Green, The Decline and Fall of Science, 1976, p. 173)