An announcement by government authorities in the UK that drugs which are too expensive should not be prescribed even if they prolong life, because the money could be better spent elsewhere, has caused an uproar.
The National Institute for Clinical Excellence (NICE), the government's medicines watchdog, has rejected four new drugs for kidney cancer even though they have been shown to extend life by five to six months.
The decision comes after pressure from the drug industry to apply the so-called "rule of rescue" for costs to be set aside in cases where treatment is deemed necessary to save life.
NICE says the natural impulse to go to the aid of individuals in trouble such as when vast resources are used to save a sailor lost at sea, should not apply to the NHS.
NICE has decreed that if drugs are too expensive they should not be prescribed even if they prolong life and counters advice from its own citizen's council, which recommended two years ago that it should adopt a "rule of rescue" as an essential mark of a humane society.
NICE says "the powerful human impulse to help an identifiable person whose life is in danger, no matter how much it costs", could mean that spending too much on one patient may deny others when there are limited resources.
NICE's 27 man citizen's council says that individuals in "desperate and exceptional circumstances" should sometimes receive greater help than can be justified by a "purely utilitarian approach."
The move has elicited criticism from many quarters including the British Medical Association (BMA), which says doctors had a duty to do their best for patients.
The BMA says they would be opposed to ignoring a rule of rescue when it introduces a degree of flexibility around extreme cases.
A NICE website report, Social Value Judgements, includes advice on the treatment of smokers, drinkers and the obese and rejects arguments that people whose illnesses are self-inflicted should get less or no treatment.
However it does say treatment may be withheld where behaviour reduces the chances of success, unless patients agree to change - therefore an alcoholic who refuses to quit drinking could be denied a liver transplant.
Such a philosophy could also suggest that treatment may also be refused to elderly patients if the benefits are deemed too low or the risks too high.
Critics say when billions are spent on research it is hard to understand why are people denied the benefits and many are calling for a debate on healthcare rationing but the British government appears to be reluctant to engage in a public debate about the issue.
They argue that state funds would be under less pressure if certain treatments which offer marginal or cosmetic benefit were removed from state funding, and more funds would be available for new "life-saving" drugs.