“We felt that the term Rule of Rescue was open to different interpretations – ranging from immediate life-saving to improving the quality of life of the terminally ill – and was therefore unhelpful in answering NICE’s questions. We therefore replaced the term Rule of Rescue with ‘exceptional case’.
When we were asked whether NICE should reject the Rule of Rescue a minority of us (6 out of 27) were opposed to any exceptional case treatment, arguing that the NHS does not have a duty to save life at any cost. It has a duty to groups as well as individuals.
A majority (21 out of 27) said that it should not be rejected completely and it should be applied in certain exceptional cases.
Recognising that the NHS does not have infinite resources, this majority group were able to specify when NICE should apply the Rule of Rescue and define what these limits should be.
Factors NICE need to consider when developing their criteria for applying the Rule or Rescue:
␣ Is the intervention required to avoid immediate loss of life?
␣ Is there a good chance of an increased life expectancy?
␣ Will it result in a significant improvement in quality of life? Are the treatment’s side effects very severe and do they outweigh the good the treatment would do?
␣ What will be the consequences should the treatment not be received?
␣ What are the alternative treatments and how do they compare?
␣ Are future medical gains probable because of the research engendered by the treatment?
␣ Are the costs prohibitive to the NHS? To what extent does it increase the burden of costs on the NHS and society at large?
␣ To what extent is cost effectiveness demonstrable? ␣ Are there good grounds for believing it would set a precedent for other
patient groups lobbying for less cost effective treatments?
␣ Will it avert danger to public health e.g. threat of an epidemic?
␣ Will people feel society’s worth is diminished if it appears to be acting inhumanely by ignoring the Rule of Rescue?