By Hilary White

February 7, 2008 ( – In 1945, the great 20th century Christian apologist, C. S. Lewis, wrote a science fiction novel in which he proposed an alternative British history. In this history a government-funded scientific think tank, the National Institute for Coordinated Experiments (N.I.C.E.), dictates government policy according to eugenic, utilitarian principles.

In that novel, That Hideous Strength, the ironically acronymed N.I.C.E. takes over Britain and attempts to create an anti-human totalitarianism in which human rights are abolished and people are used as disposable tools in medical and social experiments. The guiding principles of Lewis’ N.I.C.E. are immediately familiar to people on the pro-life side of our current Culture Wars: a mechanistic and ultra-utilitarian, anti-life philosophy that regards human beings as merely a disposable means to an end.

In today’s Britain, these same nihilistic philosophies are being adopted by the medical establishment and government, with effective abortion-on-demand and increasing calls for legalized euthanasia. Over sixty years after Lewis warned what might be the outcome of an overweening anti-Christian materialist philosophy, combined with the union of state, industry, and academia, and the manipulation of the mass media, reality is coming increasingly to resemble fiction.

And it seems beyond a coincidental irony that a real-life, government-funded organization that bases its decisions on the same utilitarian principles, could be known by the same acronym: N.I.C.E.

Set up by the Labour government in 1999, the National Institute of Health and Clinical Excellence (N.I.C.E.) produces “guidance” for the NHS on what drugs and treatments should be provided by Britain’s government-funded health system. From the extraction of wisdom teeth, to the funding of Alzheimer’s drugs, to the provision or withdrawal of nutrition and hydration to disabled patients, N.I.C.E. lays down what will and will not be paid for by Britain’s National Health Service.

Classical utilitarianism proposes that medical treatment ought to produce “the greatest good for the greatest number,” a formula that has been translated by bioethicists into the three euphemistic principles of “justice”, “beneficence”, and “autonomy”. As they are interpreted by bioethics committees, these new principles are at odds with the classical, Natural Law, or Christian-based medical ethics that start with the principle, “do no harm” to an individual patient. The new utilitarian principles, in the matter of a nationalized health system where private medical care is largely unavailable, require that some are judged worthy of treatment and others not, in order to benefit the greatest number possible. 

The N.I.C.E. describes its template of criteria as being based on “efficacy and cost effectiveness,” in which a key formula is the “quality adjusted life year” (QALY). The QALY “takes into consideration the quality of life of the patient during any additional time for which their life will be prolonged”. The clinical and cost effectiveness of the treatment is then used as the basis for a recommendation as to whether or not the treatment should be provided.

Other aspects of the N.I.C.E. criteria include the concept of the “cost per quality adjusted life-years gained” (CQG). The CQG examines the cost of treatment, divided by the estimated years to be gained by the treatment and creates an “overall cost benefit ratio”, giving the “cost per quality adjusted life-year gained”. Under this criterion, cancer treatment for a small child may deliver many more years of “quality of life” than the same treatment on an elderly patient.

The case of Leslie Burke, a retired postman with a degenerative motor neurone disease, is illustrative. Burke sued the government for the right not to be denied nutrition and hydration when his illness rendered him unable to swallow or communicate. He won his first case in 2005 with a judge ruling that denying nutrition and hydration “would be a breach of claimant’s rights under . . . the European Convention on Human Rights.” But the General Medical Council and the Department of Health appealed and won.

The head of scientific development and bioethics at the Department of Health, Elizabeth Woodeson, argued in the case that the NHS, according to the guidelines laid down by the N.I.C.E., must retain the right to dehydrate such patients to death or “there would be considerable risk of inefficient use of NHS resources.”

She said, “The Secretary of State believes that…clinicians should be able to follow the N.I.C.E. [quality of life] guidelines without being obliged to accede to patient demands.”

“If that principle were undermined, there would be considerable risk of inefficient use of NHS resources.”

As Wesley J. Smith noted in the Burke case, “It all boils down to two concepts that are increasingly intertwined in modern bioethics theory and practice. First is the so-called quality-of-life ethic that presumes to judge the worth of patients’ lives according to their mental and physical capacities. Under this view, doctors or bioethicists may judge a life to be of such low quality that it is not worth extending, irrespective of the patient’s wishes.”

Leslie Burke himself noted dryly that he was aware that “bioethicists have a low opinion of the quality of life of people with profound disabilities.”

The N.I.C.E. continues to be controversial. It is regularly criticised by patients’ groups and doctors who say that its decisions have deprived patients of needed medications and treatments.

More recently, government ministers this month are promoting the use of long-term chemical contraceptives, shown to cause serious health risks for women, including death, on the grounds of a N.I.C.E. recommendation of cost-effectiveness. News reports today revealed that the Department of Health has launched a £26.8 million drive to encourage younger women to have contraceptive implants or injections.

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