Saturday, January 15, 2011

Death Panels

The father was a doctor, the mother a nurse. They pleaded with their GP to give their three year old daughter Lana the flu vaccine. She wasn't in the "at risk" group so they were denied. She went ahead to contract the disease and tragically died anyway.

The father, Dr Zana Ameen angrily called on the Government to make the flu vaccine available to all children under the age of 5. How does £8 (the vaccine cost to the NHS) compare to the life of a child he reportedly asked.

I believe that something like five children under 5 have died of flu in the current outbreak so the chances of such death under the current vaccination regime must be less than one in a hundred thousand. So at least 100,000 vaccinations would be necessary to prevent one death, at a cost of around a million pounds.

Dr Zana Ameen also had a choice of popping around to Boots, where he could have bought a flu vaccine for £12.99 according to newspaper reports.

We have a centralised, top-down system of health care in this country where the experts (backed up by expert cost-benefit analysis) make the decisions as to who gets treatment and who doesn't. Of course, if you don't get treatment, you could die. In the US this approach to socialised medicine was tagged with the emotive phrase "death panels": not wholly wrong if it's your child who gets to die.

The alternative relies on individual choice and market mechanisms. Dr Zana Ameen could have simply exercised his choice and bought the vaccine for his daughter himself. This option has attracted moral opprobrium from Health Service professionals, with some calling for the market in vaccines to be made illegal. This is a difficult argument to make convincingly: in interviews senior bureaucrats have been reduced to that shoddy time-worn argument "we know best". Not too convincing when your daughter just died.

Here's an honest argument in defence of "death panels". Vaccines, like most things, are a scarce commodity. To distribute them you can either rely upon prioritisation or market mechanisms. In the former case the bureacrats decide (no doubt with the best of motives) who gets to receive potentially life-or-death treatments; in the latter case those with money do the deciding. The egalitarian case is for the former since all lives are equally worthwhile (really?*).

IMHO neither position seems tenable by itself. So we muddle through with the NHS a bulk buyer in the market running a free-at-the-point-of-use rationing system and the market also providing treatment options for those the NHS excludes but who can nevertheless afford to pay. I have to say that for a vaccine costing less than £20 pretty much everyone in the UK could afford to pay if they wanted it.

Since the NHS had plenty of opportunity to put in the order it wanted in advance, I think we should hear less from their ideologists about how private buyers are "taking treatments away from the deserving". You really do have a moral right to buy treatment for yourself in a legal and open market if that's how you want to spend your money, don't you?


Having recently turned 60, my screening letter for bowel cancer arrived in the post this morning. Based on perfectly-orthodox cost-benefit analysis, I completely subscribe to the logic of participating, even if there didn't happen to be a history of the disease in the family. The pack arrives in two weeks.

* There is a "gut-instinct" ethics question where you are invited to consider a burning house. If you rush in the front door and turn right you get to save your child; if you turn left you can save some number of unrelated children. Which way do you turn?

The preference for close kin over unrelated individuals is of course evolution 101. However, post-neolithic states with millions of inhabitants have to make generic policies (see "nepotism"). They therefore create an ideological concept of "citizen", all of which are to be considered equal. This conflicts with:

* kin preferences
* the obvious realities of inter-personal differences
* the differing utilities of people to the common good.

For attempts to buttress the essential homogeneity of "citizens", see "political correctness".