Should the Government or the Patient Decide What is Medically Necessary

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The Alfie discussion boils down to who should make the decision to terminate medical care to a patient. Should it be the Government or should it be the Patient and/or their family? Which is more ethical? Who do you want making your decisions when you or someone you love is on the deathbed?
 
What about a third option…a for profit insurance company?
 
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A time honored standard for doctors: First, Do No Harm.

Withholding nutrition is doing harm.

I cannot see any “medical necessity” that requires nutrition to be withheld.

The government has no business in ordering a stop to nutrition especially when it goes against the wishes of the parents. They have a right to provide their child nutrition. It is only a question of where and who pays.
 
The consideration, in my point of view, should be made first by the doctor. Then, the doctor should explain to the patient, or in this case the pateint’s parents, the situation.
Then they decide.

Right to life shouldn’t be infringed.
 
Kaninchen said:
Where does that happen?
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In the news this week:

Alfie Evans was a nearly 2-year-old British child with a mysterious, terminal degenerative neurological condition. Against his parents’ wishes, the hospital where he was receiving care withdrew life support; his parents were barred by British courts from seeking care for Alfie elsewhere.
 
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GratefulFred said:
Alfie Evans was a nearly 2-year-old British child with a mysterious, terminal degenerative neurological condition. Against his parents’ wishes, the hospital where he was receiving care withdrew life support; his parents were barred by British courts from seeking care for Alfie elsewhere.
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What had that to do with the Government?
 
The desire of the patient can sometimes not only be bad for him or her, but also futile and a resource burden.
 
The Church is very clear on this.
We are permitted to allow a person to pass naturally, but they must be hydrated and not hastened in death.
Every family should have the (name removed by moderator)ut of a good priest in such times as these crises.

There are many instanced of hospital staff urging people to sign off on sustenance removal.
A friend who is a bioethicist said it happened to his grandmother. When he mentioned he was a PhD in bio ethics, the hospital staff and doctors all fled the room.
They knew what he was going to say.
 
Alfie’s case had nothing to do with the Government. The decision was taken by the court. The court’s duty was to support the interests of the child.
 
The medical professionals should outline what options are available in a way the patient or patients next of kin can understand. Ideally they should come to a decision together.

A mentally competant patient can refuse treatment against the doctors advice.

When the patient is unable to decide for themselves and the family and doctors disagree then some form of 3rd party should mediate.
 
Do courts interpret laws past by the legislature and enforced by the executive?
 
The ‘government’ had no say in this decision.

Alder Hay is an NHS Foundation Trust. Those working themselves into a frenzy over the UK health system would do well to actually understand how the UK health system works and what this actually means:

The money is collected through taxes, but all decision making is entirely devolved from the central government. Decisions on health are made at the local level by Comissioning groups and NHS foundation trusts.

Alder Hay is a foundation trust hospital. Foundation trust hospitals were created for the sole purpose of allowing local areas to have control of their own services and delivery without any (name removed by moderator)ut from the government.

This document will explain:

https://www.wwl.nhs.uk/Library/Foundation_Trust/Foundation_Trust_Guide.pdf

For those who wont click on the link:

‘‘NHS Foundation Trusts are at the cutting edge of the Government’s commitment to devolution and decentralisation in the public services, and are at the heart of a patient-led NHS. They are not subject to direction from Whitehall. Instead, local managers and staff working with local people have the freedom to innovate and develop services tailored to the particular needs of their patients and local communities’’

‘‘NHS Foundation Trusts are established in law with a new bespoke form of public ownership as independent Public Benefit Corporations. This means far greater local ownership and involvement of patients, the public and staff rather than control from the Department of Health. The principles behind NHS Foundation Trusts build on the sense of ownership many local people and staff feel for their hospital.’’

‘‘NHS Foundation Trusts are a new type of NHS Trust in England. They are part of the Government’s plan for creating a patient-led NHS. The aim of these reforms is to provide high quality care, shaped by the needs and wishes of today’s patients, in the most efficient way. NHS Foundation Trusts have been created to devolve decision-making from central Government to local organisations and communities so they are more responsive to the needs and wishes of their local people. They are also at the leading edge of many of the other reforms and improvements that are creating a patient-led NHS. 2.3 NHS Foundation Trusts are no longer subject to direction from the Secretary of State for Health. Instead, NHS Foundation Trusts establish stronger connections between themselves and their local communities. Those living in communities served by a hospital of an NHS Foundation Trust can become a member of that organisation. The membership community of each NHS Foundation Trust is made up of local people and staff, with patients and carers also having the option to become a member.’’

The government has no interest or say in the decisions made by Alder Hay - Alder Hay is free to make its own decisions on patient care and what they provide. That is the entire point of devolving services.
 
The most important part to note is:

NHS Foundation Trusts are different from existing NHS Trusts in the following ways:

■ They are independent legal entities – Public Benefit Corporations.
■ They have unique governance arrangements and are accountable to local people, who can become members and governors. Each NHS Foundation Trust has a duty to consult and involve a Board of Governors (comprising patients, staff, members of the public and partner organisations) in the strategic planning of the organisation.
■ They are set free from central Government control and are no longer performance managed by Health Authorities. As selfstanding, self-governing organisations, NHS Foundation Trusts are free to determine their own future.
■ They have new financial freedoms and can raise capital from both the public and private sectors within borrowing limits determined by projected cash flows and therefore based on affordability. They can retain financial surpluses
 
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Whomever is footing the bill should have the final say in what is performed.

The Catholic Church doesn’t require extraordinary means to keep someone alive.
 
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_Ruby said:
Alder Hay is an NHS Foundation Trust. Those working themselves into a frenzy over the UK health system would do well to actually understand how the UK health system works and what this actually means:
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It should also be pointed out that private healthcare is available in the UK and that significant funds had been raised by crowdfunding. In other words, lack of finance wasn’t the problem.
 
Unfortunately I think facts just don’t permeate when people are determined to think Teresa May is hosting a mass UK death panel meeting every Tuesday at 2pm.
 
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