Not allowing top-up fees is unethical

doi:10.1136/bmj.a164

BMJ 2008;336:1205 (31 May), doi:10.1136/bmj.a164

Letters

Top-up fees

Not allowing top-up fees is unethical

The first 150 words of the full text of this article appear below.

Bloor bases the argument against top-up fees on fairness, particularlythe desire not to allow the wealthiest automatic access to thebest drugs, while those who cannot pay for private care aredisenfranchised.¹ The flaw in this argument is that the wealthiestalready access their own treatment, often exclusively in theprivate sector. It is poorer patients who get caught in the"trap" of potentially being disallowed NHS care if they payfor so much as one course of treatment with a top-up drug. Thegreatest iniquity and inequity is surely to disallow citizensand taxpayers their NHS entitlement in the name of fairness.

These mechanical socialist arguments are propagated througha belief that people should be in charge of their own destinybut must accept what the state gives them. It is more importantto be equal than be allowed to extend the quantity or qualityof life. This . . . [Full text of this article]

Christoph C Lees, NHS consultant

¹ Cambridge CB2 2QQ

cclees@compuserve.com