Lord Saatchi argues that legal precedent leaves doctors liable for negligence if they deviate from common practice
First do no harm is the basic medical duty, but for patients with lethal diseases, the ethical line between doing no harm and failing to do any good is blurred. All the more so with those terminal cancers where the clinical consensus is for brutal interventions which achieve no more than stretching out an unremitting prognosis. The terrible choice is sometimes between fatal passivity, and poisons and procedures that can only postpone, and at the price of immediate harm.
Such tragic dilemmas are described by Maurice Saatchi, in recalling his late wife’s case. He’s desperate to see them transcended in the future. An advertising guru as opposed to a medic, he cannot produce a treatment himself; instead he’s devised a private member’s bill aimed at freeing clinicians to do so. Lord Saatchi argues that legal precedent leaves doctors liable for negligence if they deviate from common practice; seeing as – he says – “innovation is deviation”, patients are condemned to put up with the same treatments which have been underperforming for decades.
Few oncologists are as gloomy about what they have achieved since the 1970s – childhood leukaemia and breast cancer are only two malignancies that are no longer the death sentence that they once were. But there are indeed other cancers where survival rates have barely shifted, particularly many so-called rare cancers where it is hard to assemble the volume of cases required to run the sort of protocol-compliant clinical trials that would be needed to rewrite the text books. “So-called” rare cancers because, although infrequent individually, there are so many varieties that they tot up into a far from rare phenomenon, accounting together for – on some estimates – one in six British deaths.
Opinion is divided on how far current rules actually inhibit innovation – some doctors say that with a sufficiently bleak prognosis, it is easy to demonstrate that experimentation is in the patients’ interest. But the costs of marketing and recouping investment in bespoke drugs for a tiny pool of patients do retard progress in the pharmaceutical industry; a law that clarified and highlighted physicians’ right to innovate on the wards instead would surely give the frontiers of progress a useful nudge.
Even if technology eases one set of ethical dilemmas, financial pressures could create others that ought not be dismissed – innovative treatments given in advance of Nice approval for NHS use might benefit wealthy self-paying patients, but not immediately anyone else. In the end, however, humanity as a whole will benefit from conquering cancer in the same way that it has conquered other ailments before. And there is inspiration to be found in Lord Saatchi’s determination to do something for life after death.