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If that requires an increase in taxation, that must occur. See Maynard (2001) for further discussion. g. transport). ❚ Decisions are made as to how to divide up the health budget among the different bodies and organisations within the NHS. ❚ A local body may decide how to allocate its budget to meet the needs of people in its area. ❚ A doctor may decide whether or not a particular treatment is cost-effective. The role of NICE The National Institute for Health and Clinical Excellence (NICE) plays an important role in rationing decisions.
Is it right that individuals at one point in time can determine what treatment they will receive at a later point in time (see Dresser (1994))? Is it possible for someone to know what they will want when later becoming incompetent? Or do advance directives provide a way of helping people keep control of their lives, even when they lose capacity? How are decisions to be made on behalf of an incompetent person? KEY STATUTE This is (at first) an easy question. The answer is that the decision must be made based on what is in the best interests of the person.
Problem question Angelina is aged 25 and has been badly injured in a car crash. Doctors wish to use a new treatment which has been developed following embryo research, without which it is very likely she will die. Angelina has been seen by a psychologist who explains that she is aware that she is very ill, but is finding it very difficult to concentrate because she is in great pain. The psychologist says that Angelina is not in a position to understand the exact nature of the treatment she is being offered, or the risks associated with it.