The case

Child B, or Jaymee Bowen as she was later revealed to be, was suffering from leukaemia. She developed acute lymphoblastic leukaemia when she was five and received a bone marrow transplant. She appeared to recover but in January 1995, when she was 10 she was diagnosed as suffering from acute myeloid leukaemia. NHS consultants at both Addenbrookes and the Royal Marsden hospitals said that she had only about eight weeks to live and that the only possible treatment, intensive chemotherapy and a second bone marrow transplant, was very unlikely to succeed, unpleasant and not in her best interests.

Her father refused to accept this and sought opinions from other doctors in Britain and the United States. He found a consultant in London who was prepared to treat his daughter in the private sector, but Cambridge and Huntingdon Health Authority refused to grant the £75,000 needed for the treatment. Jaymee's father challenged this refusal in the High Court. The Court ruled that health authority should reconsider its decision but this was immediately overturned on appeal.

The case attracted much publicity and an anonymous private benefactor paid for the treatment Jaymee's father wanted her to have. Intensive chemotherapy met with only limited success and so the consultant decided to treat Jaymee Bowen with an experimental treatment, donor lymphocyte infusion. Jaymee went into remission and survived longer than the experts had expected. However, in May 1996 she died.

Newspaper response

This case demonstrated how difficult it can be to make rational, reasoned choices - particularly when the media become involved. There was an enormous amount of media attention - with 149 articles being published over the six day period of the case. Many articles suggested that NHS funds were wasted on less worthy uses - funds which could have been used to treat Jaymee Bowen. Examples of less worthy uses of NHS funds cited by the papers included administration, managers' cars, abortions, cosmetic surgery, sex change operations and health education 'propaganda'.

For a number of papers the case provided evidence of rationing 'creeping into the NHS'. For instance "The case has brought into sharp and public focus the simple, central truth of modern state-provided medicine. The National Health Service cannot possibly afford what is now medically possible" The Independent 11.3.1995 and "These latest examples raise fears that rationing of life saving resources is not just creeping into the NHS but is already entrenched" The Daily Telegraph 11.3.1995.

Analysis

Entwistle, Watt, Bradbury and Pehl, reviewing this media coverage, are concerned by "their selective presentations". They conclude "Decisions about the treatment of seriously ill children and the rationing of health care are both complex and emotive....Publicity brought the case and some of the issues it raised into the open, but it did not necessarily leave people well informed. In particular, the question of whether the treatment was in the child's best interest was relatively neglected. Child B became "the girl refused treatment on the NHS" ...The current climate...means that even cases that are primarily about clinical effectiveness and a patient's best interests come to be seen as examples of rationing."

Conclusion

This case raises many questions, some of which have been touched on in this unit. However, you also should look at Unit 2 for a free market perspective and Unit 3 for some thoughts on whether individuals can decide what is in their own best interest.

The Child B case was seen by many as an example of health care rationing. How could such rationing be organised? Look at 'Approaches to rationing' on the next page for some thoughts on this.

Now look at these (check the status bar for information)