Painful choices

There has long been general societal agreement that palliative care for those with life-threatening and terminal illnesses does need to be supported.

Jonathan Ellis (Platform, 9 August) goes further in saying that now is not the time for the NHS to be diverting resources in the face of increasing demand and implying that support for such care should be ring-fenced even as overall NHS funding is being restricted.

This does lead by default to a reduction of support in other areas of health need. Mr de Beaux’s example in this context that there is a conflict between enabling terminal cancer sufferers to gain a month or two more of life by prescribing really expensive drugs and, say, helping larger numbers of morbidly obese patients for the same money, highlighted the ­dilemma.

There are many other life-threatening debilitating illnesses for which more support could give better outcomes, such as chronic obstructive pulmonary disease and strokes. There is again, by default, a conflict in choosing where to spend a relatively larger proportion of a total declining budget.

There is clearly no easy answer. The whole issue needs debate and direction at governmental level, with as many inputs as possible from “stakeholders” with interests.

One suggestion has been that it is flawed to favour those with allegedly self-inflicted health problems such as obesity over the terminally ill, but this is fallacious – what about lung cancer and heart disease associated with smoking, or liver dysfunction associated with heavy drinking. Equally terminal but “self-inflicted”.

Then again there are work-associated debilitating diseases, asbestosis and mesothelioma and black-lung come to mind, should there be more help from sufferers’ employers? How does malignant melanoma occurrence from early exposure to burning sunshine or sunbeds fit in when the risks were not fully spelled out?

Joe Darby

Cullicudden

Dingwall, Ross-shire