Why NICE is right to be nasty

For once I agree with NICE. However, this is about as crass as anything one might find in the Daily Mail:- If the family really need the extra few weeks they can now use the top up system to buy the drug for themselves without compromising the rest of their loved one's NHS care. If it's that important, cancel the order for the plasma screen, put up with the taunts about having last year's X-box, get a loan. Ronald Graves

An interesting and thought provoking article Copperfield! A neat and tidy argument in favour of NICE's decision. However nothing about death and bereavement is neat and tidy. I do not agree with NICE's decision as it results in the worst of both worlds. NICE cannot de-invent sorafenib, so doctors, patients and their families will automatically continue to consider its use when the time arrives. The availability of the top-up system complicates the matter. Firstly, there is the obvious issue that it will be the rich who can easily afford the treatment, while a poorer patient may feel bad about saddling the family with debt. But also, the top-up system puts families in the position of having to decide either to pay-up regardless of any financial difficulties to keep the loved one going a bit longer, or to be their 'Lord-High Executioner' by allowing them to die sooner. Any pet owner will tell you it is hard enough to make (and live with the consequences of) such a decision when your pet is sick and are faced with potentially huge vet's bills - so how would it be when the subject is a close relative? Either way, the eventual bereavement will likely be complicated by feelings of guilt and/or resentment. You are right to mention that some die suddenly without the opportunity for 'peace' - that happened to my 21 year old son nine years ago. But, if he had to die, I am grateful that it was sudden, and that we didn't face months of painful uncertainty followed by highly charged emotional decisions on whether we agree to his and/or his doctor's request for us to pay up to prolong his life a little. Of course we would have paid up without hesitation - but we are lucky enough to afford to without the spectre of prolonged debt being added to the awful legacy of his death. Janette Lockhart

A deliciously Dickensian view of life and livers. The sun sets on us all, in some cases it's fast, hot and red (usually involving a sports car), in others it's smouldering and jaundiced with sorafenib tantilisingly out of reach. At the moment of death the word NICE will be the last thing on my lips. Kev