Amelia McDonald is a grandmother of 63. She is much loved by her two sons, Angus and Martin, and by her grandchildren, Thomas, Annette and Abigail.

18 months ago Amelia was diagnosed with pancreatic cancer. Slowly she changed from being a spritely sexagenerian who loved taking her grandchildren to play in the park to being a sickly bed-ridden old lady. Because of her pain medication she is only semi-conscious most of the time.

Last week the oncologist informed the family that Amelia had at most a month to live.

Yesterday a new drug for the treatment of pancreatic cancer became available. It is called panozidol. On AVERAGE it allows people with Amelia's type of cancer another six months of good quality life.

That's the average. In practise the results are highly variable. Around a quarter of sufferers appear to gain no benefit. A small number who were literally at death's door are still enjoying a good quality of life two years after being treated by panozidol.

The treatment consists of a SINGLE injection. It is VERY expensive.

The entire cost of the treatment is paid up front.

You are the minister of health. It is your job to set policy for Medicare.

How much do you think Medicare should be prepared to pay for treatment with panozidol?

If the manufacturer of panozidol refused to accept what you consider to be a reasonable price would you be prepared to deny Amelia and those like her a shot at another six months or more of good quality life?

This is a hypothetical. To the best of my knowledge there is no such drug as panozidol. Nonetheless this does encapsulate many of the quandaries facing those who manage and set policy for Medicare.

So what's a shot at another 6 months of life worth?

Dear Steven,

I remember when two important new medicines,
(that are now commonly used in the treatment
of mild to moderately severe Alzheimers
disease) were listed on the Pharmaceutical
Benefits Scheme (PBS)in Feb 2001.

The PBS subsidy reduced the cost to consumer's
of a month's supply of Aricept and Exelon from
about $300+ to a maximun of $21.90 for general users
or $5.00 for concession card holders.

These drugs became available by prescription only,
with a referral from the GP to a specialist - who
then decided if the drugs would benefit the
patient.

The same could be done in your hypothetical case
with the injections.

Foxy,

That would reduce the cost to Amelia McDonald or her family.

But it would transfer the cost to the TAXPAYER.

So as minister of health how much TAXPAYERS' money are you prepared to spend to give Amelia McDonald and others in her position a shot at six months or more of good quality life?

$1,000?

$10,000?

$100,000?

What?

Suppose there are 1,000 people every year in Amelia McDonald's position. Are you prepared to spend, say, $100 million of taxpayers' money to give each of them a shot at 6 – 24 months of additional life?

Remember there will be other expensive treatments out there that can prolong life for a few months for people with other conditions. The total cost could easilty run into billions.

Remember, money spent on prolonging the life of cancer patients for 6 – 24 months is not available for, say, hip replacements or improving aboriginal education.

Hard choices have to be made.

It's inescapable.

We are talking about Giving someone a six month "bonus" period of extra life.

Question, what are they going to do with it?

spend the kids inheritance?

Party hard until they drop?

Do all the things they would not do when they had a lifetime ahead to regret them ?

Speaking personally - and I think that is the only way of answering this question, if it were my 6 momths, I would not bother.

Actually, my only request for expiring is I would sincerely wish it comes as a complete surprise, out of the blue, so to speak and of course, I will be, of course, totally unprepared. Except, I do have a will to enact following my departure,

It is wrong to deny a person medication simply because they will soon doe anyway. All human life is sacred and there is a moral obligation to ensure that this person receives any available medication that can prolong and improve her life.
Operating on terminally ill patients my cost the tax payer money, but medical staff also obtain experience from this and this is beneficial to society as a whole.
Refusing medical help to any person because of their age or current state of health is totally immoral.

Dear Steven,

It is a difficult choice. Possibly
one that should involve the cancer
victims, and their families.
As well as their medical specialists.

We're all tax payers. We're all intitled
to Government funded schemes.
Ones that a medical specialist would
decide on the criteria for who
was eligible. Some people would not
want to take up the option, as Col pointed
out.

As for the costs involved - for the taxpayer?
We in Victoria have the Grand Prix - which
is costing us over 38 million in the red every
year (and rising).

Then there's the billion dollar shipping channel in
Port Philip that's already being called a "White
Elephant," by experts.

The Government wastes billions in "Schemes" that
are often questionable. One dealing with human
lives seems to me, should be worth considering.
What if some new medicine was discovered during
those six months when life was prolonged?

If I had to choose, The Grand Prix?
or World Youth Day?
or my mother living for another six months ?
What would I choose?

My mother - without hesitation.