Doctors told to be honest with patients

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The Independent Online
CANCER SPECIALISTS at a hospital that cannot afford to provide the drugs patients need have been told they must tell the truth about the shortage of money.

Consultants at the Royal Surrey County Hospital NHS Trust, whose budget for cancer drugs has been cut by pounds 150,000 this year, had agonised over whether to tell patients that drugs were available but too expensive or pretend that there was no effective treatment for their condition, to protect them from the truth.

The consultants complained about their ethical dilemma to the trust's board, which obtained legal advice on the issue. Lawyers wrote to the consultants, saying they must be open and honest with their patients.

Professor Hilary Thomas, an oncologist at the hospital, said: "I can't prescribe drugs that I could 18 months ago for ovarian cancer, and I find that very, very difficult. I have patients who are young and relatively fit and I have a dilemma about whether I am completely honest with them and leave them with the awful thought that if they were private patients they would be offered treatment, or do I be paternalistic and not tell the truth?"

Professor Thomas said the cut in the cancer drugs budget had been imposed because the trust was pounds 1.4m in the red. "Now we have got to claw back pounds 150,000 when it was quite obvious we couldn't manage last year. I don't blame the trust or the health authority because this is a national crisis."

If the same policy of openness were adopted by other cancer clinics, it would provoke fresh protests about underfunding and increase pressure on the Health Secretary, Frank Dobson. Spending on cancer drugs is estimated to be 30 per cent less in the UK than in other European countries and survival is lower. Some health authorities have imposed blanket bans on drugs such as Taxol for ovarian cancer, and other drugs such as irinotecan for bowel cancer and vinorelbane for lung cancer are also rationed.

Doctors meeting at the British Medical Association's annual conference in Belfast will demand today that decisions on rationing be reached by an "open and informed" public debate.

Cancer consultants at the Royal Surrey Trust told the board they had been put in an "invidious" position in relation to patients they could not afford to treat. In reply they received a letter from the trust's solicitors, Hempsons, setting out the requirement for honesty and openness with patients.

Professor Thomas said: "I must say I found that reassuring. But what do you then do? Patients are left thinking that if they had pounds 5,000 they could go and get the drugs privately."

She said she had applied for funding for the drug topotecan to treat a woman with ovarian cancer last October but the trust had changed the rules and she did not pursue it. The woman died last month and now she had to face her husband, who had made an appointment to see her.

"I think he wants to look me between the eyes and ask me whether it would have made any difference if she had got the drug. I honestly don't think so but we could have tried and if it wasn't working we would have stopped. If it had worked she might still be here now."