If You Were Gravely Ill, Would You Want an Experimental Treatment?
UK lawmakers are contemplating clarifying the law to allow doctors to offer terminally ill patients unconventional drugs and procedures, something that so far seems to have received strong public support.
The legislation, called the Medical Innovations Bill, would clear the way for doctors to try new medical techniques (but not to experiment) or use medications outside of their traditional use if they feel they can help gravely ill patients and if those patients give their express consent.
Originally proposed by Lord Saatchi in 2012, a revised bill will be offered in Westminster’s upper chamber, the House of Lords, on Thursday. Lord Saatchi’s legislation comes from having watched his sadly deceased wife die of ovarian cancer and a conviction that more could be done to fight these fatal diseases if doctors did not fear lengthy court battles if they try unusual medical interventions.
The bill’s key effect will be to change the point at which the so-called Bolam Test is applied. At the moment, if a doctor tries a procedure and is then taken to court due to a complaint, a panel of specialists must see whether the experimental procedure was justified. The legislation would mean that the test would be applied before the treatment is given, thus hopefully improving both safety and the possibility of innovation.
Now, a report on a public consultation over the legislation shows that the public seem to overwhelming support the spirit of the bill. Individual doctors, scientists and charities have also backed the legislation.
“Over the past few months, in one of the largest public consultations ever undertaken in this country, the people have agreed that there is a problem with how we are treating some of the sickest in our society,” Lord Saatchi is quoted as saying. “We have a culture of defensive medicine in the NHS, a culture created by the fear of litigation that hangs over doctors. Last year, the health service paid £1.2bn in lawsuits. The Bill has obviously touched a nerve. Why? Because people know that all cancer deaths are wasted lives. If the Bill receives Royal Assent after scrutiny in both Houses of Parliament, good doctors will be protected and encouraged by the law.”
The latest version of the legislation has been reworked to respond to concerns that there could be a slippery slope and that it might affect patient rights. The reworked bill makes it clear that the legislation only gives doctors legal clarity to do something that, in most cases, is actually already technically legal, while also ensuring that the law will add further safeguards so that quack cures cannot be tried. For instance, any application for an experimental procedure would have to be taken before a review board and examined in detail. Though, here arises the main problem with the bill as it is currently written.
For instance, a statement issued by the Royal College of Surgeons in April notes that the legislation could both help to innovate in medical science and safeguard against abuses of the system. However, the advisory body is concerned that among other things, the legislation in its current form allows the doctor wanting to try an innovative treatment to ultimately disregard the advisory body’s findings on whether the treatment to be tried is appropriate. This appears to be the major area of contention for a number of medical bodies, including the Academy for Healthcare Science which oversees many NHS practices. It is also an area over which most of the British press seems to have skipped (if they’ve read the bill at all).
A second issue with the bill is that it frames the current law in a way that miscasts what is actually legal. It offers that doctors will at the moment be found negligent if they depart from traditional practices. That’s not necessarily true if the doctor follows all standard care protocols. As such, the legislation will need to be re-worked in order to give an accurate picture of the current state of the law and what will be changed.
This of course isn’t an obstacle that is insurmountable and the problems could be addressed during parliamentary debate. The UK’s health secretary, Jeremy Hunt, has said he will back the bill if there is strong support. An independent adviser is due to give his recommendations on the legislation this week, but reports suggest a favorable outlook.
So should doctors be allowed to offer patients unorthodox methods of treatment if they meet rigorous care standards? Many people seem to say yes because, when there is nothing to lose, there is a lot to gain. Obviously, there are concerns that every step of this change should be closely monitored and that the emphasis should always be on patient care and not just innovation, but if this balance can be struck it seems the UK is ready to support patients working with their doctors as they try unconventional medical treatments that could, potentially, save people from pain or even save lives.
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