- Email: [email protected]
More difficult decisions for UK doctors
R;.oa:.,’X.. . _ y. . °YS. _.__ ,.m;,Y, , _ ’:,’,.<’:.md:_
’.’"
readers, the majority of whom voted
cherish the integrity of the human body, took advantage of the turnabout to deride the Christian Democrats, with VVD leader Frits Bolkestein announcing, "The v Christian Democrats have decided that v the human body is State property". In Parliament Lansink explained that his party had been listening to and been convinced by the arguments of the kidney and the heart patients’ associations. The change was a "matter of solidarity", he said. "We do not belong to ourselves, but to each other", Lansink told his fellow
parliamentarians. The proposed regulations
’.j . _ _
against their bodies becoming "state-
More difficult decisions for UK doctors
owned" in the context of organ donations. The newspapers have published Doctors in England and Wales will be many letters on the issue. The left-ofexpected to play a larger part in whether centre Vólkskrant, too had many letters with long-term health-care needs critical of attempts to set into law how patients will be provided for by the National consent should be given. : Health Service. This indication came The shortage of organs is serious. With from a Department of Health report this kidney donations, for example, falling week that aimed to clarify the responsibilifrom 426 in 1993 to 366 in 1994, the ties of the NHS for the elderly and infirm waiting list for kidneys has grown-to who require continuing health care.’ 1644 individuals, who have been waiting The guidelines address some of the a mean of 4.7 years. In 1994, 81 patients concerns raised the health service on the list died. : ombudsman last by in a year special report to
:
have dominated media coverage the past week. The
parliament
right-of-centre pro-VVD morning paper De Telegraaf conducted a poll among its
on
long-term nursing
care.
This had been prompted by complaints Marjanke Spanjer about the NHS withdrawing from providing continuing health care and highly publicised instances of NHS patients being US lawsuits tobacco transferred to private nursing homes for which they were expected to pay fees. A series of court rulings against tobacco babies by cigarettes be included in the Such actions went against the 1989 guideinterests has set the stage for a new round suit was followed, but the dollar amount lines from the Department of Health, of lawsuits against major cigarette makers was not included in the total damages. which stated that "No NHS patient and promises to ease the winning of The tobacco companies have filed a petishould be placed in a private nursing awards by tobacco victims and even by tion with the state Supreme Court chalhome or residential care home against taxpayers. The rulings have been made in lenging the constitutionality of the law. his/her wishes if it means that he/she or a different states. Tobacco stock shares fell : They claim that the Florida Agency for relative will be personally responsible for as a Louisiana judge approved the first Health Care Administration, which filedthe home’s charges" (see Lancet 1994; federal class-action suit ever issued the suit against them, lacks the necessary 343: 407). of tobacco the state :: against companies, legal power. A decision may take weeks. According to the new guidelines, the The class-action certification granted hospital consultant will be responsible for Florida filed a suit seeking "billions of : dollars" for the cost of treating Medicaid by a federal judge in Louisiana creates: deciding what type, within the confines of victims of smoking-related illnesses, and what may be the largest class-action case local eligibility criteria, of continuing in US history by allowing tens of millions health care the patient should have. This another disputed suit in Mississippi was : of smokers to be parties in the case. They: decision should be made after a multidisallowed to go to a juryless court. Three states besides Florida have also would be represented by a national con- : ciplinary assessment of the patients needs. sued over Medicaid expenses but only sortium of about 50 law firms, each comThe British Medical Association is conmitted to spending$100 000. Judge Okla :: cerned about the nature of the decisions Florida has passed a law that enables the state to bypass the defences traditionally Jones said the class of "nicotine-depen- : that consultants will be expected to make used by tobacco companies to repulse dent" smokers will include all smokers: and the burden of responsibility that it will bring. The guidelines also announce smoking-related lawsuits. In the past, medically diagnosed as being nicotinecompanies have been able to convince dependent, as well as smokers who have :. the creation of a new right of appeal for been warned by their doctors that smokjuries that they were not liable for smokpatients who have been found ineligible illnesses because smokers ing-related ing is dangerous yet have not quit. How- : for NHS continuing care. Appeals will be chose to smoke despite warning labels. ever, Jones did not endorse the central: considered by advisory panels, which will But in Florida the state will not have to contention that cigarette makers have be able to call for independent clinical prove that each smoker’s illness was due long known their products are addictive: advice. Again, this will mean that doctors to smoking. Instead, the law, called the but concealed that information and will have to assume greater responsibility 1994 Medicaid Third Party Recovery manipulated nicotine levels to keep smokfor deciding which patients get NHS conallows of statistical ers hooked. the use evidence :: tinuing care and which do not. Act, The case stems from a lawsuit called: showing that a certain percentage of canThe criteria that that consultants will cers are due to smoking (see Lancet 1994; the Castano case, named after Dianne A. use to decide whether patients are eligible 344: 253). The other three states with Castano, widow of Peter Castano, a New: for NHS treatment will vary according to Orleans lawyer who died of lung cancer geographical area, since they will be set pending Medicaid suits are Mississippi, that was allegedly caused by smoking. Minnesota, and West Virginia (see Lancet : locally rather than nationally. It is the 1994; 344: 942). Industry lawyers opposed class certificahealth authorities that will decide what Originally it was announced that Flori- : tion partly on grounds that the : each area’s criteria for qualifying for NHS da would seek US$1.4 billion, but later number of potential claimants would: long-term care are. They now have to that was amended to "billions of dollars". : make the case unmanageable. : develop draft local policies and eligibility Tim Howard, Florida’s lead attorney in : In Mississippi, a judge ruled that a lawcriteria for continuing health care. These the case, said the latest Centers for Dis- : suit against tobacco companies could go: should be made publicly available for conease Control and Prevention studies show : to trial in chancery court, which does not: sultation and finalised by April 1, 1996. that the damages could be double the : use a jury. Chancery court typically hears such cases as contract disputes, in conSarah Ramsay original estimate and that damages will continue to accrue during the two to five : trast with circuit courts, which hear perresponsibilities for meeting continuing : 1 NHS years before a court decision is expected. : sonal injury and liability cases. health care needs. Available from Also, he said, a suggestion by the BritishCommunity Care Unit, NHS Executive, based Association for Nonsmokers Rights Room 3EO1, Quarry House, Leeds, LS2 that harm caused to low-birthweight 7UE, UK Harry Nelson ,
against
companies
i
large
!
574
’.’"
readers, the majority of whom voted
cherish the integrity of the human body, took advantage of the turnabout to deride the Christian Democrats, with VVD leader Frits Bolkestein announcing, "The v Christian Democrats have decided that v the human body is State property". In Parliament Lansink explained that his party had been listening to and been convinced by the arguments of the kidney and the heart patients’ associations. The change was a "matter of solidarity", he said. "We do not belong to ourselves, but to each other", Lansink told his fellow
parliamentarians. The proposed regulations
’.j . _ _
against their bodies becoming "state-
More difficult decisions for UK doctors
owned" in the context of organ donations. The newspapers have published Doctors in England and Wales will be many letters on the issue. The left-ofexpected to play a larger part in whether centre Vólkskrant, too had many letters with long-term health-care needs critical of attempts to set into law how patients will be provided for by the National consent should be given. : Health Service. This indication came The shortage of organs is serious. With from a Department of Health report this kidney donations, for example, falling week that aimed to clarify the responsibilifrom 426 in 1993 to 366 in 1994, the ties of the NHS for the elderly and infirm waiting list for kidneys has grown-to who require continuing health care.’ 1644 individuals, who have been waiting The guidelines address some of the a mean of 4.7 years. In 1994, 81 patients concerns raised the health service on the list died. : ombudsman last by in a year special report to
:
have dominated media coverage the past week. The
parliament
right-of-centre pro-VVD morning paper De Telegraaf conducted a poll among its
on
long-term nursing
care.
This had been prompted by complaints Marjanke Spanjer about the NHS withdrawing from providing continuing health care and highly publicised instances of NHS patients being US lawsuits tobacco transferred to private nursing homes for which they were expected to pay fees. A series of court rulings against tobacco babies by cigarettes be included in the Such actions went against the 1989 guideinterests has set the stage for a new round suit was followed, but the dollar amount lines from the Department of Health, of lawsuits against major cigarette makers was not included in the total damages. which stated that "No NHS patient and promises to ease the winning of The tobacco companies have filed a petishould be placed in a private nursing awards by tobacco victims and even by tion with the state Supreme Court chalhome or residential care home against taxpayers. The rulings have been made in lenging the constitutionality of the law. his/her wishes if it means that he/she or a different states. Tobacco stock shares fell : They claim that the Florida Agency for relative will be personally responsible for as a Louisiana judge approved the first Health Care Administration, which filedthe home’s charges" (see Lancet 1994; federal class-action suit ever issued the suit against them, lacks the necessary 343: 407). of tobacco the state :: against companies, legal power. A decision may take weeks. According to the new guidelines, the The class-action certification granted hospital consultant will be responsible for Florida filed a suit seeking "billions of : dollars" for the cost of treating Medicaid by a federal judge in Louisiana creates: deciding what type, within the confines of victims of smoking-related illnesses, and what may be the largest class-action case local eligibility criteria, of continuing in US history by allowing tens of millions health care the patient should have. This another disputed suit in Mississippi was : of smokers to be parties in the case. They: decision should be made after a multidisallowed to go to a juryless court. Three states besides Florida have also would be represented by a national con- : ciplinary assessment of the patients needs. sued over Medicaid expenses but only sortium of about 50 law firms, each comThe British Medical Association is conmitted to spending$100 000. Judge Okla :: cerned about the nature of the decisions Florida has passed a law that enables the state to bypass the defences traditionally Jones said the class of "nicotine-depen- : that consultants will be expected to make used by tobacco companies to repulse dent" smokers will include all smokers: and the burden of responsibility that it will bring. The guidelines also announce smoking-related lawsuits. In the past, medically diagnosed as being nicotinecompanies have been able to convince dependent, as well as smokers who have :. the creation of a new right of appeal for been warned by their doctors that smokjuries that they were not liable for smokpatients who have been found ineligible illnesses because smokers ing-related ing is dangerous yet have not quit. How- : for NHS continuing care. Appeals will be chose to smoke despite warning labels. ever, Jones did not endorse the central: considered by advisory panels, which will But in Florida the state will not have to contention that cigarette makers have be able to call for independent clinical prove that each smoker’s illness was due long known their products are addictive: advice. Again, this will mean that doctors to smoking. Instead, the law, called the but concealed that information and will have to assume greater responsibility 1994 Medicaid Third Party Recovery manipulated nicotine levels to keep smokfor deciding which patients get NHS conallows of statistical ers hooked. the use evidence :: tinuing care and which do not. Act, The case stems from a lawsuit called: showing that a certain percentage of canThe criteria that that consultants will cers are due to smoking (see Lancet 1994; the Castano case, named after Dianne A. use to decide whether patients are eligible 344: 253). The other three states with Castano, widow of Peter Castano, a New: for NHS treatment will vary according to Orleans lawyer who died of lung cancer geographical area, since they will be set pending Medicaid suits are Mississippi, that was allegedly caused by smoking. Minnesota, and West Virginia (see Lancet : locally rather than nationally. It is the 1994; 344: 942). Industry lawyers opposed class certificahealth authorities that will decide what Originally it was announced that Flori- : tion partly on grounds that the : each area’s criteria for qualifying for NHS da would seek US$1.4 billion, but later number of potential claimants would: long-term care are. They now have to that was amended to "billions of dollars". : make the case unmanageable. : develop draft local policies and eligibility Tim Howard, Florida’s lead attorney in : In Mississippi, a judge ruled that a lawcriteria for continuing health care. These the case, said the latest Centers for Dis- : suit against tobacco companies could go: should be made publicly available for conease Control and Prevention studies show : to trial in chancery court, which does not: sultation and finalised by April 1, 1996. that the damages could be double the : use a jury. Chancery court typically hears such cases as contract disputes, in conSarah Ramsay original estimate and that damages will continue to accrue during the two to five : trast with circuit courts, which hear perresponsibilities for meeting continuing : 1 NHS years before a court decision is expected. : sonal injury and liability cases. health care needs. Available from Also, he said, a suggestion by the BritishCommunity Care Unit, NHS Executive, based Association for Nonsmokers Rights Room 3EO1, Quarry House, Leeds, LS2 that harm caused to low-birthweight 7UE, UK Harry Nelson ,
against
companies
i
large
!
574