Box 2.

: Denying patients a new treatment

• A doctor working in an NHS trust thinks it wrong that his patients will be denied a new treatment for cancer (the hospital formulary committee had decided that it should not be prescribed). Should he contact the local media? Should the trust punish him if he does?
• The “balance” principle recognises that a tension exists between what is good for individuals and for populations. It was probably on these grounds that the committee decided that the new drug would not be made available. The “cooperation” principle suggests that the doctor should cooperate with his colleagues and implies that contacting the media would not be helpful. But the “openness” principle means that the committee should be open with patients, doctors, and the community (through the media perhaps) on why it is denying patients a drug. The doctor might decide that the hospital is not living by the openness principle and so contact the media himself. If he does that, he should abide by the openness principle and give the whole story, not just his version. If the trust has lived by the principles and the doctor has not, then it might be legitimate to punish him. It clearly would not be legitimate if the doctor lived by the principles but the trust did not.