5 ms·

NHS has nothing to do with electing to pay for your own treatment - people do it sometimes for elective stuff. That was a court of law which ruled in that case

NHS has nothing to do with electing to pay for your own treatment - people do it sometimes for elective stuff. That was a court of law which ruled in that case (and then again for multiple appeals processes), the NHS has no such power.

pmyteh 6y ago
This is exactly right. Where the NHS won't pay you're free to go private. This case, and that of Charlie Gard, were quite different. The dispute was a welfare one: whether the best interests of the child (Alfie) were to be allowed to die, or to undergo experimental treatment where it was pretty clear it would have no benefit. There's quite a good explainer (which sets out why it was both complicated and emotional) in Vox[0]. But it can't be stressed enough that this was about who makes the decisions, not about who pays for care. The money was there to pay for the alternative treatment (fundraised, in this case). The question was whether the parents have the right to make the final decision, or the courts. And English law is very clear that in the end the High Court has the power to make care decisions in place of the parents when it believes it is acting in the best interests of the child. And that extends to withdrawing care and allowing the child to die. You may not want judges to have that degree of power. That, honestly, they exercise it extremely carefully may not be a comfort. You may think that the parents' view should always control. That's fine. But that has nothing to do with the NHS and its funding system. The same issues would arise even if the child was in a private hospital and the parents wanted to pursue futile treatment against the advice of the medical staff. https://www.vox.com/policy-and-politics/2018/4/27/17286168/alfie-evans-toddler-uk-explained https://www.vox.com/policy-and-politics/2018/4/27/17286168/a...
- daenz 6y ago
  >But that has nothing to do with the NHS and its funding system. It does. It is much more legitimized to delegate these kinds of decisions to the state when the state is paying for the health care. In other words, the state paying for care is a pre-requisite to the state having the ability to make these kinds of extreme/overruling decisions about care. Otherwise people wouldn't tolerate it. The state paying for care is a power dynamic. Consider the opposite, of a state that doesn't pay for any care, telling Alfie Evans parents that they have to take him off of life support, and tell me that you think the social reaction would be the same and people would just accept it. They wouldn't, and that shows you how much the issues are linked. Again, it's a power dynamic that increases legitimacy.
  - iso1210 6y ago
    There are several cases in the US where courts override parents wishes, while it's true US courts tend to give more rights to the parent than the courts in determining what's best for the child - at least for middle class parents - in Custody of a Minor (and other cases), the court held that family autonomy is not absolute. For your "opposite" case, where a court could order removal of a baby from life support, there have been several cases in America https://www.chron.com/news/houston-texas/article/Baby-dies-after-hospital-removes-breathing-tube-1926032.php https://www.chron.com/news/houston-texas/article/Baby-dies-a... "Sun's death marks the first time a U.S. judge has allowed a hospital to discontinue an infant's life-sustaining care against a parent's wishes, according to bioethical experts. A similar case involving a 68-year-old man in a vegetative state at another Houston hospital is before a court now."
    - daenz 6y ago
      I'm not arguing that it has never/will never happen in America. I was trying to be careful with my wording, eg "more legitimized." I think that a place where healthcare is government funded is more likely to accept decisions that other places consider overreaching by the state. My underlying point is the power dynamic between a government and its people, and the argument that a government "providing" more things increases that dynamic in the favor of the government. This makes any decisions related to that dynamic more legitimized.
      - iso1210 6y ago
        Do you have any evidence to back up your claim? The US government provides 27% of things in the US (budget vs GDP), about the same as South Korea and Switzerland, more than Ireland (23%), less than New Zealand (32%), UK (33%), Spain (34%), but not by an extreme amount.
        daenz 6y ago
        >The US government provides 27% of things in the US (budget vs GDP) This is silly. Budget vs GDP is not how you measure how much a government provides. You're not controlling for waste.

pmyteh 6y ago

This is exactly right. Where the NHS won't pay you're free to go private. This case, and that of Charlie Gard, were quite different. The dispute was a welfare one: whether the best interests of the child (Alfie) were to be allowed to die, or to undergo experimental treatment where it was pretty clear it would have no benefit. There's quite a good explainer (which sets out why it was both complicated and emotional) in Vox[0]. But it can't be stressed enough that this was about who makes the decisions, not about who pays for care. The money was there to pay for the alternative treatment (fundraised, in this case). The question was whether the parents have the right to make the final decision, or the courts. And English law is very clear that in the end the High Court has the power to make care decisions in place of the parents when it believes it is acting in the best interests of the child. And that extends to withdrawing care and allowing the child to die. You may not want judges to have that degree of power. That, honestly, they exercise it extremely carefully may not be a comfort. You may think that the parents' view should always control. That's fine. But that has nothing to do with the NHS and its funding system. The same issues would arise even if the child was in a private hospital and the parents wanted to pursue futile treatment against the advice of the medical staff. https://www.vox.com/policy-and-politics/2018/4/27/17286168/alfie-evans-toddler-uk-explained https://www.vox.com/policy-and-politics/2018/4/27/17286168/a...

daenz 6y ago
>But that has nothing to do with the NHS and its funding system. It does. It is much more legitimized to delegate these kinds of decisions to the state when the state is paying for the health care. In other words, the state paying for care is a pre-requisite to the state having the ability to make these kinds of extreme/overruling decisions about care. Otherwise people wouldn't tolerate it. The state paying for care is a power dynamic. Consider the opposite, of a state that doesn't pay for any care, telling Alfie Evans parents that they have to take him off of life support, and tell me that you think the social reaction would be the same and people would just accept it. They wouldn't, and that shows you how much the issues are linked. Again, it's a power dynamic that increases legitimacy.
- iso1210 6y ago
  There are several cases in the US where courts override parents wishes, while it's true US courts tend to give more rights to the parent than the courts in determining what's best for the child - at least for middle class parents - in Custody of a Minor (and other cases), the court held that family autonomy is not absolute. For your "opposite" case, where a court could order removal of a baby from life support, there have been several cases in America https://www.chron.com/news/houston-texas/article/Baby-dies-after-hospital-removes-breathing-tube-1926032.php https://www.chron.com/news/houston-texas/article/Baby-dies-a... "Sun's death marks the first time a U.S. judge has allowed a hospital to discontinue an infant's life-sustaining care against a parent's wishes, according to bioethical experts. A similar case involving a 68-year-old man in a vegetative state at another Houston hospital is before a court now."
  - daenz 6y ago
    I'm not arguing that it has never/will never happen in America. I was trying to be careful with my wording, eg "more legitimized." I think that a place where healthcare is government funded is more likely to accept decisions that other places consider overreaching by the state. My underlying point is the power dynamic between a government and its people, and the argument that a government "providing" more things increases that dynamic in the favor of the government. This makes any decisions related to that dynamic more legitimized.
    - iso1210 6y ago
      Do you have any evidence to back up your claim? The US government provides 27% of things in the US (budget vs GDP), about the same as South Korea and Switzerland, more than Ireland (23%), less than New Zealand (32%), UK (33%), Spain (34%), but not by an extreme amount.
      - daenz 6y ago
        >The US government provides 27% of things in the US (budget vs GDP) This is silly. Budget vs GDP is not how you measure how much a government provides. You're not controlling for waste.