Tuesday, January 29, 2008

Many British Physicians Call for Refusal of Medical Treatment for Smokers and Others with "Unhealthy Lifestyles"

According to an article in The Telegraph, a survey of British physicians revealed that many support the denial of medical treatment to the elderly as well as to people with "unhealthy lifestyles," such as smokers and the obese. Also on the list of those to whom medical treatment should be denied - according to many British physicians - are people seeking "social abortions" or fertility treatment.

According to the article: "Doctors are calling for NHS treatment to be withheld from patients who are too old or who lead unhealthy lives. Smokers, heavy drinkers, the obese and the elderly should be barred from receiving some operations, according to doctors, with most saying the health service cannot afford to provide free care to everyone. Fertility treatment and "social" abortions are also on the list of procedures that many doctors say should not be funded by the state."

"The findings of a survey conducted by Doctor magazine sparked a fierce row last night, with the British Medical Association and campaign groups describing the recommendations from family and hospital doctors as "out­rageous" and "disgraceful." About one in 10 hospitals already deny some surgery to obese patients and smokers, with restrictions most common in hospitals battling debt. Managers defend the policies because of the higher risk of complications on the operating table for unfit patients. But critics believe that patients are being denied care simply to save money." ...

"Among the survey of 870 family and hospital doctors, almost 60 per cent said the NHS could not provide full healthcare to everyone and that some individuals should pay for services. One in three said that elderly patients should not be given free treatment if it were unlikely to do them good for long. Half thought that smokers should be denied a heart bypass, while a quarter believed that the obese should be denied hip replacements."

The Rest of the Story

The fallacy in the argument being used to support denial of medical treatment for smokers and others with "unhealthy lifestyles" is that the true incentive to deny care is not a clinical one, but instead is based on either a desire to save money or a moral judgment about individual behavior. Either way, it is a dangerous way of thinking - one that should be universally condemned by all of us in the medical and public health professions.

By definition, physicians who support the denial of medical care on a systematic basis to various groups of people are not basing the decision on clinical judgment. Because by definition, clinical judgment requires that a decision be made on a case-by-case basis, taking the specific details of the individual patient into account.

As soon as we leave the realm of individual clinical decision-making and instead, make decisions based upon policies that apply to groups of people, then we are abandoning the reliance on clinical judgment in favor of making our decisions based on other factors, whether they be financial concerns or an attempt to impose moral judgments on others.

In the case of the denial of "social" abortions (the simple description of abortions as being "social" I find despicable), it is clearly an attempt to impose one's individual morals on the rest of society. There is no place for that in the medical profession.

In the case of the denial of medical treatment to the elderly, smokers, and the obese, it is clearly an attempt to save money for the government - and ultimately, the taxpayer. There is also no place for that in the medical profession.

My hope would be that anti-smoking groups would immediately and publicly condemn these proposed policies. Unfortunately, I doubt any anti-smoking groups will speak out on this issue. If they are not even willing to oppose the idea of taking away the legal recourse of nonsmokers to seek accommodation if their health is being affected by tobacco smoke from neighboring apartments, then I can't imagine that these groups would speak out against the maltreatment of active smokers.

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