R v. Cambridge Health Authority, ex parte Beckwith

[1995] 2 All ER 129 (CA); [1995] EWCA Civ 49
Download Judgment: English

The child “B” had a long history of unsuccessful treatments fo her cancer. In January 1995,  B suffered a further relapse of acute myeloid leukaemia. Both the doctor who oversaw B’s treatment since the initial diagnosis and the doctor who performed a prior bone marrow transplant agreed that the child had approximately six to eight weeks to live and that no further treatment could “usefully be administered.” B’s father, unhappy with this determination by the doctors, contacted other medical experts. There was response that a further two-step treatment might be possible but such treatment would not be available in sufficient time to the patient under the public health system, so the family was encouraged to use the private system. All parties agreed that the likelihood of success was very low. The family requested that the Cambridge Health Authority (the “Authority”) provide the funding for such treatment. The Authority deemed the treatment experimental based on the low likelihood of success and therefore declined the funding. B’s father sought judicial review of that decision.

The lower court quashed the Authority’s decision on four grounds: (1) that the Authority failed to consider the wishes of the patient; (2) that the classification of the treatment as experimental was incorrect; (3) that the Authority referenced lack of resources, but failed to be specific as to what other medical goods or services it needed those resources for; and (4) that the Authority wrongly evaluated the cost of the claim at £75,000 when the initial step of the treatment would only cost £15,000.

The Authority appealed the lower court’s decision

The Court granted the Authority‘s appeal of  the earlier decision.

In deciding to grant the Authority’s appeal, the Court addressed the four criticisms made by the lower court against the decision of the Authority. First, the Court found that the wishes of the patient, expressed through her family, were clear throughout the decision-making process of the Authority. Second, the Court found that the proposed treatment was not one with a proven track record of success and was therefore appropriately considered “experimental”. Third, the Court found that it was common knowledge that there were resource constraints at health authorities and that difficult judgments had to be made as to the use of limited resources. To require the health authorities to provide specific account information as a way of justification for denying a treatment would be unrealistic. Finally, the Court found that the Authority was correct in measuring the treatment cost at £75,000 as this would be the full cost of the two-step procedure (chemotherapy and a bone marrow transplant). In conclusion, the Court felt that the Authority was within its power in reaching its decision and therefore granted the appeal.

“Our society is one in which a very high value is put on human life. No decision affecting human life is one that can be regarded with other than greatest seriousness.” Page 7.

“The inescapable fact is, however, that he was put under perfectly legitimate, but very obvious, pressure by the family to procure this treatment and he was responding to that pressure. It was because he was conscious of that pressure that he obviously found the decision which he had to make such an agonising one and one calling for such careful consideration. To complain that he did not in terms say that he had regard to the wishes of the patient as expressed by the family, is to shut one's eyes to the reality of the situation with which he was confronted.” Page 7.

“The plain fact is that, unlike many courses of medical treatment, this was not one that had a well tried track record of success. It was, on any showing, at the frontier of medical science. That being so, it does not, in my judgment, carry weight to describe this decision as flawed because of the use of this expression.” Page 7

“I have no doubt that in a perfect world any treatment which a patient, or a patient's family, sought would be provided if doctors were willing to give it, no matter how much it cost, particularly when a life was potentially at stake. It would however, in my view, be shutting one's eyes to the real world if the court were to proceed on the basis that we do live in such a world. It is common knowledge that health authorities of all kinds are constantly pressed to make ends meet. They cannot pay their nurses as much as they would like; they cannot provide all the treatments they would like; they cannot purchase all the extremely expensive medical equipment they would like; they cannot carry out all the research they would like; they cannot build all the hospitals and specialist units they would like. Difficult and agonising judgments have to be made as to how a limited budget is best allocated to the maximum advantage of the maximum number of patients. That is not a judgment which the court can make. In my judgment, it is not something that a health authority such as this Authority can be fairly criticised for not advancing before the court.” Page 8.