Grace Jaccarini, co-ordinator of Nursing and Midwifery Studies at the Institute of Health Care (The Sunday Times, October 15), wrote that nurses are usually special people doing skilled work that not just anyone is able to do. She described nursing as a very dynamic profession, changing and going according to the ever-present challenges that need to be faced. In fact the change in the professional competences required of health professionals and others such hospital managers is no small change.
The time when students, especially health managers, were taught that they were obliged to do everything available to lengthen life and improve its quality is long gone. When considering the high cost of new medicines, such as in cancer treatment, the health professional or whoever is asked to decide which medicine to buy and which not, is in fact putting a value on an individual patient's life.
Therefore now a university providing a proper education has a duty to help students gain the necessary experience and capabilities to take ethical and professional decisions which may result in deciding which patients are to live and for how long and which are to be allowed to die. This is why many professional courses last four or five years. Gone are the days where one had only to teach students how to develop "skills" and how to act ethically and compassionately.
In addition to their traditional work, health professionals need "to carry out activities contributing to health or its recovery or peaceful death that an individual would perform unaided if one had the necessary strength, will or knowledge, helping patients regain their independence as rapidly as possible."
But there is more to it than that. Today health professionals may even have to explain to patients that they would have to meet an earlier death or to not to enjoy the best possible quality of life because the state cannot afford to pay in their case. Very often they may be called upon to assist their politician or health administrator to select, often weighing all pros or cons, which are the most deserving cases and which are not. Students preparing for these "special" professions need to be taught how to make the best decisions with the resources available.
In the health field we are witnessing the development of high-technology medicines and techniques. As these new technologies generally come at a high cost, health professionals are faced with the daily challenge of balancing cost and efficacy.
High-cost medicines present a particular challenge as they are often associated with disease states with high morbidity or mortality rates. Doctors and pharmacists on the wards, or as members of drug and therapeutic committees, as well as accountants and economists at the budgeting office all want to do their best for our patients but they all have to consider the impact of decisions on the rest of the organisation and indeed of the country.
Therefore today the University has to ensure that pharmacy students are equipped not only with the knowledge of the pharmacology and pharmaceutics of a particular medicine but also to know the cost of medicines and trained to make decisions based on evidence.
Ultimately health professionals and budget providers are making a judgment on whether or not a new medicine represents "value for money". They need to be educated on how to make such a judgment.
Decisions on how to budget in health care needs are extremely complex and will vary from one country or society to another. It is very difficult to harmonise these requirements even on a European level since it is not feasible for all needs and expectations to be provided for. There will always be the need for fixed budgets.
Governments increasingly expect health care providers, especially those who are publicly funded, to operate efficiently. Ray Fitzpatrick, consultant editor to Hospital Pharmacy Europe (September/ October issue) stated: "Universities need to teach undergraduate students not only the law relating to medicines, but also expose them to these complex ethical dilemmas." It is not only pharmacists who need to take notice of this advice, it is all health professionals who must sooner rather than later face a fixed budget in other words they will be required to put a value on an individual patient's life.
Although one should not shy away from educating the public, including through a more open debate on the issues, some politicians, media gurus, and the unlearned public tend to become cynical on this subject (often to cover their incomprehension of its complexity). It is important to educate health professionals well in this field since this area is too serious a matter for them to become cynics as well.