Hannah Jones has refused the heart transplant that could save her life. But is a 13-year-old too young to make that decision? Or is she the only person who can?
When Jamie Ross was just 19, he was diagnosed with Hodgkin's disease. His response? A darkly humorous blog describing the tribulations and indignities faced by a young man with a serious illness
The National Institute for Health and Clinical Excellence proposes to reject a breast cancer drug despite its own rule changes on end-of-life treatments Wednesday 21 October 2009 18.11 BST A drug which can give women with advanced breast cancer extra weeks or months of life has been turned down by a government watchdog body for use in the NHS. The National Institute for Health and Clinical Excellence (Nice) says it proposes to reject Tyverb (lapatinib) in spite of changes in the rules brought in specifically to allow people at the end of their lives to have the chance of new and often expensive treatments. Tyverb is the only drug licensed for women with advanced breast cancer whose tumours test positive for a protein called HER2 and for whom Herceptin, a Nice-approved drug, is no longer working. In much of the rest of Europe, Tyverb is then given, in combination with a standard chemotherapy drug called capecitabine.
Hospital patients in England will get the legal right to be seen privately if they face NHS delays. Hospitals have to start treating patients within 18 weeks of referral - or two weeks in the case of cancer. But ministers will now give patients a legal right to private care - or treatment at another NHS centre if so desired - if this does not happen. The Tories, who would scrap waiting time targets, said it was an "unaffordable and uncosted" pledge.
This article examines the implications for patient care, and for the future of rationing within the NHS, of the recent decision to permit NHS patients to supplement their care by paying for medicines — mainly expensive new cancer drugs — which are not available within the NHS. The starting point is the recommendations of the Richards' Report and their implementation through new guidance issued by the DoH and NICE. Practical challenges arise from the insistence upon the 'separate' delivery of self-funded medicines, and more flexible cost-effectiveness thresholds for end of life medicines may have repercussions for other patients. While undoubtedly part of the trend towards explicit rationing, top-up fees might also represent a significant step towards regarding the NHS as a core, basic service. Finally, the issue of top-up fees is located within the broader context of current cancer research priorities and persisting health inequalities.
Doctors will be allowed forcibly to sedate the 55-year-old woman in her home and take her to hospital for surgery. She could be forced to remain on a ward afterwards. The case has sparked an intense ethical and legal debate. Experts questioned whether lawyers and doctors should be able to override the wishes of patients and whether force was ever justified in providing medical care.
A cancer patient who has a phobia of hospitals should be forced to undergo a life-saving operation if necessary, a High Court judge has ruled. Sir Nicholas Wall, sitting at the Court of Protection, ruled doctors could forcibly sedate the 55-year-old woman - referred to as PS. PS lacked the capacity to make decisions about her health, he said. Doctors at her NHS Foundation trust had argued PS would die if her ovaries and fallopian tubes were not removed. Evidence presented to Sir Nicholas, head of the High Court Family Division, said PS was diagnosed with uterine cancer last year.
The National Institute for Health and Clinical Excellence (NICE) has confirmed there will not be NHS funding in England and Wales for the anti-cancer drug Avastin. It is used to combat advanced bowel cancer and research shows the drug can give an extra six weeks of life. About 6,500 people per year may be eligible for the drug. But the health watchdog argued that at a cost of nearly £21,000 per patient, the drug is just too expensive.
In this report, Professor Knaplund discusses the Montana Supreme Court case of Baxter v. State of Montana (2009 MT 449), which ruled on the issue of a doctor's liability in a physician aid in dying (PAD) situation. In this case, the plaintiff was suffering from mutual symptoms related to his terminal lymphocytic leukemia and the chemotheraphy treatments he was receiving for it. Along with several other named plaintiffs, including board-certified physicians and the group Compassion and Choice, Mr. Baxter sued to have the state's homicide statute declared to of the constitutional rights of those who are dying to seek a physician's aid in achieving death.
Women in the Irish Republic will have to be given the means to access legal abortions there if their lives are at risk, the European Court of Human Rights has ruled in a landmark judgment. The ruling, by the grand chamber of the Strasbourg court, can not be appealed and will require Ireland to legislate or otherwise set up a framework to decide whether there is a “real and substantial risk” to a woman’s life if she goes ahead with her pregnancy. The court held that the human rights of a woman with a rare cancer were violated when she was obliged to travel to the United Kingdom for an abortion and awarded her €15 000 (£12 700; $19 800) in compensation.
An investigation is under way into how two transplant patients were given kidneys from a donor with a rare and aggressive form of cancer. The incident at the Royal Liverpool University hospital involved organs from a woman who died at another hospital, and was later found to have had a hard-to-identify disease called intravascular B-cell lymphoma. Both patients had been preparing for live transplants from their sisters but accepted the donor kidneys instead. The recipients are now receiving chemotherapy treatment. Although cancer transmission is a known risk of transplantation among clinicians, the case raises questions about guidance to patients and whether sufficient checks are made. One senior of
NHS Blood and Transplant associate medical director Professor James Neuberger said transfer of malignancy was a very rare occurance but more organs were likely to carry diseases as donors get older. He admitted the scale of the problem was not known. A research fellow has now been appointed to find out how often infected organs are passed on to patients. Professor Neuberger said his first role was to try and get all the data together from transplant centres and then to work out strategies with clinicians to reduce risk.
A cancer patient who was supposed to receive regular check ups says he was devastated when he was finally seen and told the disease had spread. Retired teacher Henry Clark from Narberth, Pembrokeshire, needed three-monthly check ups at West Wales General Hospital, Carmarthen. But "serious failures" meant he was not seen for more than a year. Hywel Dda Health Board has been criticised for what happened and has apologised.
US drug regulators have rescinded approval of a breast cancer drug, saying it is not effective enough to justify the risks of taking it. The drug, Avastin, was approved for US use in 2008, but UK officials have also rejected claims that it prolongs life.
We talk, as a society, of our need to get health care costs under control. Conservatives, in particular, insist that Medicare must be reformed. Here is an enormously expensive drug that largely doesn’t work, has serious side effects and can no longer be marketed as a breast cancer therapy. Yet insurers, including Medicare, will continue to cover it. If we’re not willing to say no to a drug like Avastin, then what drug will we say no to?
Doctors have been given permission to perform potentially life-saving cancer surgery on a woman who has a "delusional belief" she does not have the disease. A judge at the Court of Protection in London ruled that the treatment would be lawful and in the best interests of the 61-year-old, who suffers from chronic schizophrenia.
A boy, Neon Roberts, who is suffering from cancer, began radiotherapy today, after his mother’s failed High Court battle to prevent him receiving the life-saving treatment.
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