February 4th, 2008
|03:48 am - Welcome to the Nanny State Part 2 -- Let the old and the fat die from lack of treatment|
As a follow up to this post, I'd like to draw your attention to this, wherein it is stated that the old and the fat are disposable, so far as UK doctors are concerned.
A few relevant quotes from the article that was based on the findings of a survey conducted by Doctor magazine:
Smokers, heavy drinkers, the obese and the elderly should be barred from receiving some operations, according to doctors
About one in 10 hospitals already deny some surgery to obese patients and smokers
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.
Gordon Brown promised this month that a new NHS constitution would set out people's "responsibilities" as well as their rights, a move interpreted as meaning restrictions on patients who bring health problems on themselves.
Katherine Murphy, from the Patients' Association, said it would be wrong to deny treatment because of a "lifestyle" factor. "The decision taken by the doctor has to be the best clinical one, and it has to be taken individually. It is morally wrong to deny care on any other grounds," she said.
Again, this is just part and parcel of a creepying nanny-statism that tries to legislate morals. The penalty for drinking, smoking and eating too much is denial of care -- a death penalty for those already ill and unable to afford private care and reliant on government care. Right now, 10% of the hospitals in the UK are denying care for just these reasons.
And the elderly? Well, they're old and likely to die anyway, so why waste the money on treating them?
This issue hits particularly hard for me, since my father died of cirrhosis of the liver brought on by chronic hepatitis that he got through a tainted blood transfusion. Because he was over 70, the doctors refused to do a liver transplant, even though there was a willing donor -- myself. I was told he was too old and they didn't want to do it and nothing either he or I said made any difference.
Shortly thereafter, he died.
How many other people's lives will be cut short by doctors who consider someone "too old to be treated"? I'd rather have had my father around for a few more years, but that choice was denied me, since doctors had determined he'd already lived long enough. Since he was otherwise fit and a tee-totaling non-smoker who was very active, I could have had him around for quite a while longer, perhaps even to the present day. Instead, I go to put flowers on his grave.
Current Mood: enraged
Current Music: "Angels of Bells" by Mothertongue
It's not quite accurate though. Obesity and smoking are clinical factors - they increase the risk of dying on the operating table. So, for non emergency treatment, they will ask people to lose weight or stop smoking.
OTOH there is a lot of evidence that doctors do decide the old aren't worth the effort
Yes, BUT . . .
How do you explain statements like this?
The survey found that medical professionals wanted to go much further in denying care to patients who do not look after their bodies.
Ninety-four per cent said that an alcoholic who refused to stop drinking should not be allowed a liver transplant, while one in five said taxpayers should not pay for "social abortions" and fertility treatment.
Paul Mason, a GP in Portland, Dorset, said there were good clinical reasons for denying surgery to some patients. "The issue is: how much responsibility do people take for their health?" he said.
"If an alcoholic is going to drink themselves to death then that is really sad, but if he gets the liver transplant that is denied to someone else who could have got the chance of life then that is a tragedy."
The alcoholic is also seen as disposable, since he is continuing to drink, and therefore not WORTHY of being treated.
Since when did doctors become vicars?
Yes, but they're sounding off. They aren't allowed to make those kinds of decisions, and if they did, they'd be contravening the Human Rights Act. It's just... bollocks.
And I'm not sure that's what they are saying about the alcoholic - what they are saying is, that the liver transplant won't work unless he stops drinking. It is actually a clinical decision to say that liver buys this man three years, and that man 23 years.
Doctors decide who gets the medical resources and who doesn't, under the NHS system. (If I am wrong here, please correct me!) Anything that affects those decisions, including the "morality" of the patient as mentioned above
, IS relevant. Deciding one patient is more "deserving" than another can affect who gets treated, and doctors' attitudes can affect those decisions. And just because something is illegal doesn't mean it doesn't occur, as you know very well, from your profession -- that's why laws are made in the first place.
The problem with the alcoholic is that the decision is being made before the transplant occurs. As mentioned in the article by Prof. Roger Williams, the alcoholic may well reform after the transplant. If he nevers gets to have the transplant in the first place, then one will never know if he would stop drinking. Given the more than 95% rate of cessation of alcohol consumption cited, the odds are vastly in favor of the alcoholic not ruining the new liver, but they aren't even being given the chance.
Plenty of people use convenient cover stories to justify less-than-laudable attitudes that are the real
reason why things happen as they do. (Just think of the "glass ceiling" women run into as they try to rise in their professions, to give just one relevant example. This one comes to mind
off-hand, since it is recent.)
If one is giving what amounts to the power of life and death to a group of persons, I believe it behooves one to keep an eye on them and the attitudes they have.
I'm not saying it isn't a good idea to keep an eye on people's attitudes and require them to justify them with evidence. And no, the doctors don't decide - a national body called NICE does, and that looks at the evidence and makes decisions accordingly. And those decisions are examinable by courts, and the court of public opinion.
OTOH, if a man can't stop drinking when he's on the transplant list, to preserve what liver function he has left, it is not irrational to predict that he's not going to stop drinking after the transplant.
If resources are limited, the amount of 'good' that can be bought with those resources is a reasonable basis upon which to ration them. It's not morality, it's utilitarianism.
No, it isn't. It doesn't consist of the OPINIONS of doctors, it consists of scientifically conducted surveys of best practice. Double blind tests, assessments of survival rates, comparisons of best practice.
~goes back and reads article~
Erm, no. It says that transplants should be denied to alcoholics who refuse to stop drinking. That's not judging recovering alcoholics. It's saying we aren't going to give someone a liver transplant if they aren't going to look after it. Really not seeing a problem with that.
Also, the BMA said the survey was wrong and nonsense, so it looks increasingly like some doctors shooting their mouths off without actually / necessarily having the power to affect such decisions or even wanting to.
What other basis is there for rationing? Seriously.
It seems you replied to the comment I deleted for bad HTML, which is reproduced below.
The opinions I was referring to were medical opinions, which may be biased. Best practice is a rather vague term -- my experience has been it means "doing what other doctors have done in the past, so we don't get sued." Being in the UK, it may have a different meaning than here.
~~ also goes back and re-reads article ~~
I'm not seeing where it says denial of transplants is happening only to alcoholics who continue to drink. The last sentence of the quote from Prof. Williams certainly seems to imply the reverse, when I read it.
The BMA would say that, since it is generating such bad publicity, so of course they are going to try to spin it and back-pedal. Which isn't to say that some doctors didn't shoot their mouths off -- the real question in my mind is to what extent, if any, do those attitudes affect patient care? If they in fact do have an influence, then that survey is quite significant, to my mind. Since the article does mention a significant proportion of UK hospitals are already engaged in denial of care, to some extent, I think it important to look at the attitudes mentioned in the survey. The part about Gordon Brown's call for a new NHS constitution is also something that I think is important for people to be concerned about, as a harbinger of what is to come.
As for having a different basis for rationing, that's a tougher nut to crack. My understanding of the UK health system is that it is supported by the taxes of everyone, both the fit and the unfit. To allow only the fit to benefit seems manifestly unfair to those who are currently unwell who paid into the system and who continue to pay into the system. "To each according to their need" might be one way of handling it, with an emphasis on preventive care so that things don't progress to the point where hip replacements and transplants are needed. Another might be you get the care you paid for, through your taxes.
In some ways, this rationing of socialized medical care is not that different from what may well happen in this country with the Social Security system, once the baby boomers retire. They will have paid in, but may not receive their fair share in benefits when it's their time to collect, given that it was created as a "pay as you go" system and there are fewer younger workers to support them than when the system was originally created.
Edited at 2008-02-04 01:41 pm (UTC)
Ninety-four per cent said that an alcoholic who refused to stop drinking should not be allowed a liver transplant.
I think it's clear that that refers to alcoholics who do not stop drinking.
Professor William's comments effectively answer a question that the doctors were not asked - should alcoholics be denied treatment. His answer is no, because of X statistic. However, that statistic's high rate of success is dependent on the filtering process that takes place by refusing to treat alcholics who don't stop drinking. Only people committed to stopping drinking get treated, therefore there is a high success rate, which means that that filtering is effective.
Also, George Best was a waste of skin, who should never have had a transplant because he was a wife beating arsehole who pissed away what changes he was given. My contempt for that man is boundless. It's not surprising that, if he's given as an example of an alcholic post-transplant, that people recoil from the idea. You have no idea what he was like.
Point conceded with respect to the 94% statistic. And with respect to the cherry-picking argument you used as well. The way the article is written, however, seems to be saying that the two are related, hence my commentary. That statistic as used seems to be implying that alcoholics are being denied treatment, simply by fact of being alcoholic, regardless of current sobriety status.
I'd never heard of George Best prior to reading that article, so to me he's just a name.
But they aren't. Honest. It's just a shit stirring article.
He was a famous footballer in the sixties, who makes men of a certain age go dewy eyed and wet their knickers at the memory of him playing. He was extremely gifted. He also was a wife beater though he didn't limit his attentions just to his wife, a serial cheater, a drunkard, and there were allegations of untoward actibvity with underage girls. As far as I know, he never stopped drinking, despite implants, counselling and an awful lot of support. It's likely he got his transplant because of his celebrity status - no one would want to be known as the man who killed George Best - than because he was going to use it for good.
They still idolise him. Named Belfast airport after him.
I'm glad to hear you say that people aren't being denied healthcare. All I read was the article saying they were, and therefore I grew incensed, particularly at the moral tone of the justifications used to ration and deny care.
When you describe Best, I can't help but think of Mozart -- extremely gifted in some ways, but with a less-than-exemplary personal life.
There isn't enough money in the system for each according to their need.
Some patients have to be given priority over others.
Then that is a different question -- either the pie has to grow, by more money being made available, or the cost of providing healthcare has to decrease. Ballooning hospital costs are a huge issue here, but I have no idea if the topic is talked about over where you are at all.
In a zero-sum situation, yes. But then how does one define relative worth among people? Who is more "worthy" of treatment? What are the criteria to be used?
In triage situations here, the sicker you are, the more likely you will be treated. From what the article seems to be stating, that isn't the case in the UK -- the less healthy are being treated while those less well but committing "health vices" are being left to twist in the wind. And that doesn't seem right to me.
But then again, I'm just a colonial. ;)
Triage works the same here as anywhere else.
This is an unscientific survey asking doctors what they think might be a good way of rationing if they had to do so. This is not the same as them having the power to do so.
Also, the BMA, which represents doctors official opinions rejected it.
So, you know, it's a pile of bollocks. This is not what is happening. This is not what stands the slightest risk of happening.
I'm glad to hear you say that it isn't happening, since I have several friends who live in Britain at present, some of whom are less-than-svelte, and I would hate to think that they would be denied care because of their weight. (Some have joint problems and consequent mobility issues.)
Your NICE sounds rather like the HMOs that we have, as a method of rationing care. The evidence it looks at would consist of the opinions of doctors, I would think, and if those opinions are biased by the aforementioned attitudes, I would think that the outcome of the decision as to who does and doesn't get healthcare would also therefore be biased.
As for the alcoholics, from what is mentioned in the article, it certainly sounds as though they are required to be dry for at least six months before a transplant can even be considered, whether or not they actually receive one or not. So at the time of the decision, it seems as though their past behavior is being looked at, not their present.
As for utilitarianism, it is a moral philosophy -- one espoused by that student of Bentham, Albus Dumbledore, when he does things "for the greater good." Use of the felicific calculus of utilitarianism can be used to justify a number of things that many people would consider unethical, such as the torture of suspected terrorists in order to ensure the security of a larger populace. It can also be used to justify failing to care for the elderly, so that the resources can be used by those younger, or for those that are very sick, in order to treat more people who are less unwell.
Use of the utilitarian argument in the healthcare field leads to a very slippery slope indeed, in my opinion.
Also, I think you are reading this article in the light of your culture and not mine.
We believe in universal healthcare, free at point of delivery. That means there has to some rationing. Because healthcare is delivered by the state and not private organisations, the control over it by the public is considerable. Anyone who messes with that principle will become unelectable.
Also, because it is delivered by the state, the legal remedies available if provision is defective are more penetrating than mere contractual ones. Our constitutional rights are brought into play.
That makes a very different environment in which to have these discussions.
Quite true -- I am. I'm insufficiently familiar with the inner workings of the NHS to do more of an analysis than I have heretofore done.
As you may know, healthcare in the US is mostly private, with some public, mostly for the indigent. Many people are unable to afford the purchase of health insurance, and for many it is available only through an employer, which makes it difficult to impossible for the self-employed to become covered. If a self-employed person does mangage to get coverage, it usually extremely expensive. A large portion of the population is not covered by health insurance, for these reasons, especially in the middle class, who are too rich to qualify for government coverage yet too poor to afford private health insurance.
Despite the private coverage, we too have to deal with rationing of care, and it is quite a hot-button topic. Tort law is the only protection many people have, when coverage is denied, and some have died because the health insurers refused to approve something in a timely fashion or at all.
As you said, a very different environment entirely. But the point I had been trying to make in the post was that denial of healthcare for those who had the "vices" of smoking, drinking or overeating was something I considered to be inherently immoral and part of a larger tendency of government, here and abroad, to micromanage people's lives, as had been mentioned in my prior post on the proposed law to ban fat people from eating in public eating establishments, a trend I personally find abhorrent.
Well, frankly, I don't think this is what is happening here - doctors in practice treat weight reduction and stopping smoking as part of the treatment process, so that you will still get your operation, but once you've reduced your weight. It's more of a holistic approach.
If you still get your operation, all well and good, but what I was seeing was people being denied healthcare, with that "About one in 10 hospitals already deny some surgery to obese patients and smokers, with restrictions most common in hospitals battling debt." So it seemed to me to be a monetary thing, with costlier patients being shown the door and their "health vices" being used as the justification, regardless of whether or not it is the true reason for the denial of service.
The less-than-laudatory attitudes being described were the icing on the cake, so to speak.
I was also less than thrilled to see that Fertility treatment and "social" abortions are also on the list of procedures that many doctors say should not be funded by the state. To me, that is part of basic healthcare for women. It's possible that it's not seen that way in the UK, though. The abortion one in particular seemed to be a moral judgement.
Some surgery - so, we'd need to know what some surgery was. Hip replacements until the weight has been reduced. Breast augmentation, what? You can't assess whehter it's a reasonable decision in the absence of full information.
I'm not sure that I see fertility treatment as basic healthcare. It's not life threatening. The abortions thing is complicated, and you would have to drill down into the attitudes presented. It may be they mean 'women who use abortion as contraception' and not 'woman with 8 children who is at the end of her tether'. It's not going to be a moral decision about abortion, because most people don't give a shit about that. It's going to be a moral decision that says treating heart patients is more important than abortions.
Quite true -- the article didn't state what surgery was being denied.
Fertility treatment can be seen as a "quality of life" issue -- very important to a woman who is eager to have children, and of no import to one who isn't interested in having copies of her DNA walking around. The term "social abortion" that the article used is rather ambiguous, as you mention. I read it as "abortion gotten for any other reason than medical necessity, such as for a tubal pregnancy, where the life of the mother may be at stake." This reading may be due to differing cultural conditions on my side of the Atlantic. :)
It can. It's also not very successful - 10% rate.
I can't judge what it means there. It could mean what you say. There would have to be a definition for results to be meaningful.
Welcome to Aldous Huxley's Brave New World!!!!!!!!!!!!!