Letter: Ethical dilemmas that daily confront NHS doctors

Sir: Your tongue-in-cheek leading article suggesting that only saints may be eligible for treatment in the 'slimline NHS' (24 May) neatly evades the difficult issues and choices that confront NHS doctors daily in the distribution of health care.

Since demand is unlimited and resources are finite it is constantly necessary to prioritise treatment. Neither the public through its politicians, nor the mass media through self-appointed spokesmen seem willing or able to indicate clear guidelines in specific situations, of which we have had some good recent examples, including fertility treatment, and bypass surgery for those who continue to smoke.

It is easy to be critical of the choices that have been made but it is important to remember that doctors themselves are very much divided on these questions. We should expect as much, since after all, doctors are themselves a cross section of our society, albeit with much greater insight into the problems of the NHS.

For the time being, therefore, doctors remain largely entitled to implement their own views in their own fields. Thus, for example, I regard vasectomy reversal and religious circumcision to have very low priorities in the allocation of taxpayers' money, and believe that most of those seeking these procedures should fund them privately. Others may feel differently. Either way, more positive advice and opinion, particularly from the public, would be most welcome.

Yours faithfully,

D. L. CROSBY

Consultant Surgeon

University Hospital of Wales

Cardiff

26 May