Treatment decisions. Whys and wherefores

A review of challenges to five health authorities' refusals to fund treatment found none of the health authorities had an explicit process for decision making which would stand up to public scrutiny. None had an appeals procedure for contested decisions. This will become an issue for primary care groups and trusts as they will face the same challenges as HAs which refuse treatment. There is the added complication that the doctors will be acting both as agents for their patients and stewards of the resources for the community of patients they serve. Where there are restrictions on treatment, conflict might be avoided by the use of widely available guidelines. Dilemmas over refusing individual patients treatment will not be entirely resolved by evidence-based decisions.