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Should lifestyle determine medical entitlement?

Health Care Life style choices 2005

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#1 Chakotay

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Posted 10 December 2005 - 11:50 AM

A bit of a debate has started on whether the National Health Service should continue to support and help patients whose lifestyle means that treatment isn't going to be as effective as would otherwise be.

This means smokers with respiratory or heart problems who don't give up.
Obese people with joint and heart issues who don't lose weight.
It could also apply to
Needle sharers who get hepatitis.
Promiscuous people who get sexually transmitted diseases.
The list could go on.

Is this the right thing to do? The NHS is famously 'free at the point of delivery for all'.
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#2 MuseZack

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Posted 10 December 2005 - 11:56 AM

Chakotay, on Dec 10 2005, 04:50 PM, said:

A bit of a debate has started on whether the National Health Service should continue to support and help patients whose lifestyle means that treatment isn't going to be as effective as would otherwise be.

This means smokers with respiratory or heart problems who don't give up.
Obese people with joint and heart issues who don't lose weight.
It could also apply to
Needle sharers who get hepatitis.
Promiscuous people who get sexually transmitted diseases.
The list could go on.

Is this the right thing to do? The NHS is famously 'free at the point of delivery for all'.

<{POST_SNAPBACK}>


Ideally, there'd be enough resources to treat everybody.  But given that medical care is a scarce resource, that means rationing.  And putting people who refuse to change their bad lifestyle choices down on the treatment list seems like a fair way of doing it.  Certainly more so than here in the US, where every rich drug addict/alcoholic celebrity seems to be able to get an organ transplant when needed while others die on the waiting lists.
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#3 Schmokie_Dragon

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Posted 10 December 2005 - 01:19 PM

This is another time when principle is good but application has yet to be proven. I think if someone does something they know will have a detrimental effect on their health, and it is a case where medical treatment must be rationed, I would rather they died than some kid who has a terrible disease but is behind a smoker with lung cancer on the waiting list

Besides, people with abysmal lifestyles need an incentive to stop, nor not start at all. The idea that they will be left to die if they dont sort their lives out seems a pretty big incentive. And I dont want taxpayers money being spent giving an boozer a new liver.

But I have also heard that such people will be denied treatment even if their condition is unrelated to the lifestyle... I hope I read that wrong.
And it may mean that people who play dangerous sports will be denied some treatment. This has to be applied very carefully to be just.
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#4 Themis

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Posted 10 December 2005 - 01:29 PM

If resources really are limited (a real shortage of a certain blood type or drug, and certainly transplant organs) then yes, treat those with the best chance of survival.  Otherwise it would pretty much violate the Hippocratic oath to refuse treatment.  

It would still be a tough call if resources were really limited - treat the person whose lifestyle might undo the treatment but who might recover and be ok for awhile or the person whose lifestyle wouldn't impact recovery but whose condition is so bad they might not recover even if you used those limited resources on them??  

Lots of ethical arguements either way.

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#5 Nikcara

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Posted 10 December 2005 - 01:47 PM

Organ transplants are frequently denied to people who refuse to stop drinking or whatnot.  Some of the disqualifications for gettinga new organ include drug abuse, history of drug abuse, alcohol abuse, history if suicide attempts, bulemia, being too old, ect.  Basically if they feel that you're going to waste their organ, you're not getting it.  I don't know if morbid obesity also puts you lower on the waiting list, but I imagine it does.

The best way to get an organ transplant is if you're young, don't do drugs, and are otherwise healthy.  One of my friends had a kidney transplant a while ago - he needed it because he was young (20somethings), no drugs, and healthy until some drunk bugger decided to get in a car and hit him with it.   From his stories it seems he got the transplant fairly quickly.

Otherwise you have to be famous enough that someone decides to give you one anyway or rich enough to buy an organ on the blackmarket and find someone willing to actually put it into you.
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#6 Schmokie_Dragon

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Posted 10 December 2005 - 02:24 PM

But organ transplants aside, what about denying lung cancer patients who smoke alot chemo? Or refusing to spend tax payers money to remove a melanoma on someone who repeatedly sunbathes in hot countries without suncream?
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#7 Nikcara

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Posted 10 December 2005 - 02:58 PM

If stupidity equalled worse medical care, more of us than you're thinking about would start getting subpar treatment.

You have the people who smoke, drink, excerise too little, exercise too much, eat too much, don't eat enough, sunbathe, don't take their vitamins in the morning, don't put on enough clothes for cold weather, put on too much clothing for hot weather, are bad drivers, ect, ect.

We've all done something stupid.  It could be argued that my getting sick is the result of my working in the medical field...so should I be punished for exposing myself to germs?  Should someone who is poor be punished for not heating the apartment well enough in winter?  Where do you draw the line at being "stupid"?  Where's the line for promiscuity, for example?  Would you ony allowed to sleep with one new partner a year?  Do you put a max on the number of times you get treated for a specific injury per year?  I knew a girl in gymnastics who broke her ankle 3 times doing it - do you drop her because she keeps going back to a sport she loves?

Basically, no, I don't beleive in denying anybody treatment.  Maybe force them to sign wavers saying they know the risks and are doing it anyway and perhaps show them a few of the more graphic images of what smoking can do.  But people are free to be as stupid as they please.  As long as there is no real shortage of whatever resource they are using up, it's their life to throw away.
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#8 Schmokie_Dragon

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Posted 10 December 2005 - 03:11 PM

The problem in the UK is that there is a shortage of time. Patients are dying because waiting lists are so long. Patients are being misdiagnosed because there is so much strss on the system that poor doctors are allowed to practice due to shortages. We need to cut down some how.

I think anyone who knows they WILL suffer medical problems from a lifestyle that has no benifits then they should be placed at the end of the waiting list. I dont agree with rescources being used to treat people who have abused their lives. The states job is not to pick up the pieces of peoples' stupidity.

If people smoke despite warnings that this is not healthy then they should not expect someone to pick up the pieces and spend money trying to fix em. This goes for many lifestyles. However, I dont think someone should be refused treatment from promiscuity. Humans are naturaly promiscuous. Thats like saying that if you get food poisoning from eating meat you should be refused treatment. Smoking, obeisity etc are "modern" afflictions (by modern I mean since civilization) They are not natural. They are totaly self inflicted.

But as I said, its a good idea in certain cases but I dont trust the NHS not to do the whole thing the wrong way.
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#9 Lin731

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Posted 10 December 2005 - 03:14 PM

Quote

A bit of a debate has started on whether the National Health Service should continue to support and help patients whose lifestyle means that treatment isn't going to be as effective as would otherwise be.

This means smokers with respiratory or heart problems who don't give up.
Obese people with joint and heart issues who don't lose weight.
It could also apply to
Needle sharers who get hepatitis.
Promiscuous people who get sexually transmitted diseases.
The list could go on.

Is this the right thing to do? The NHS is famously 'free at the point of delivery for all'.


I think this would be a dangerous path to take. Who decides what is or isn't worthy of treatment and how long before the list of the "unworthy" grows?
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#10 Jid

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Posted 10 December 2005 - 03:59 PM

Nikcara, on Dec 10 2005, 11:47 AM, said:

I don't know if morbid obesity also puts you lower on the waiting list, but I imagine it does.
It's been my understanding that if you, or your perfect donor, are too far overweight, they simply can't operate until they drop enough pounds.

(It actually happened in my hometown, where a father dropped something like 60 pounds so he could donate a kidney to his daughter)
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#11 Nikcara

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Posted 10 December 2005 - 05:22 PM

Doing surgery on people who are overweight is difficult to do for anethesia reasons.  Not only does it take more drugs to knock someone out, but fat cells will absorb it.  Once the level of drugs in the blood starts decreasing again the fat cells will slowly release it, making it very hard to know when the person will wake up.  They will either spend not enough time under because the fat cells are abosrbing too much or they will spend too long under since it is being continously released as an unknown rate.  Of course, staying out too long is much easier to fix - you just keep an eye on their vitals as you wait for them to wake up.  I once tried doing surgery on an overweight rat - with the meds we were using to to knock it out we couldn't use too much for fear of putting the animal into cardiac arrest, but it turned out we couldn't put enough in to keep it under without exceding that dose.  We gave up trying to do the surgery on that particular rat.
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#12 Natolii

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Posted 10 December 2005 - 07:48 PM

Actually, It is quite insulting to those of us with weight issues that can't lose the weight with out radical procedures.

I don't over eat, but I am having a damn hard time losing it...

:angry:

I cannot believe I am reading this. I did expect better out of you especially Chakotay. It is arrogant, insulting ...

Ugh...
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#13 Schmokie_Dragon

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Posted 10 December 2005 - 07:54 PM

I dont think anyone is suggesting those with weigh issues they cant control should be denied treatment, but those who eat unhealthily, refuse to do enough exercise, could control their weight but are too lazy etc possibly should be on the grounds that they are chosing to live in manner that jeopardizes their health. And what did Chakotay do wrong? Bring up a story that is in the news in the UK atm.... he didnt even express an opinion!

And its not arrogant to believe that when treatment is restricted those who live good lives and make the best of them should get first dibs. It arrogant to assume you can live an indulgent life and have people pick up the pieces after you.
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#14 Natolii

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Posted 10 December 2005 - 08:27 PM

I missed the last sentance.

I am just annoyed because I do have weight issues, but everyone is so quick to jump on the "He/she/it" is just lazy...

Hun, so far the only way I was successfully able to lose weight thus far...

Was from Bulima.
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#15 Schmokie_Dragon

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Posted 10 December 2005 - 09:03 PM

{{{{{{{Natolii}}}}}} not a good way to do it :(

I too have weight issues, so I can guess how you may feel. But I know my weight is mostly my problem. I dont have the time to exercise, what with exams, cadets and horses. And I comfort eat (comes from being depressed eh)

But I still belive that for those where the problem is self inflicted (such as myslef), there may be a case to deny or postpone treatment.
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#16 Chakotay

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Posted 11 December 2005 - 03:30 AM

{{{{Natoli}}}}

I'm sorry your personal weight issue has made this topic upset you. Has your doctor or health professional had any positive suggestions on how to help you that you might like to share with others who also might benefit?
Anyway, this topic is just a general discussion on a subject brewing in the UK. I think there are so many gray areas in health and medicine that laying down broad guidelines like these is way too dangerous.
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#17 emsparks

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Posted 11 December 2005 - 09:19 AM

I am Natolii’s father, and I too have “Weight issues.” I’m really very tired of the bullsh**t societal prejudice that says that obesity is a disease of choice.

What Natolii doesn’t tell you is she also suffers almost continual sleep disturbances, as do I, which has recently been medically proven to be a causative of obesity. What Natolii also doesn’t tell you is she has inherited from me an impulse disorder, which you know as Attention Deficit Disorder (ADD). Did you know that disturbed sleep is endemic among people with ADD?

Because of our sleep disturbances, we both suffer chronic sleep deprivation. If you think that a person that suffers from ADD and chronic sleep deprivation is able to finely control any portion of their life let alone eating and exercise, you have another thought coming. Why in God’s name do you think that they call it “Attention Deficit Disorder.”?

I have been fighting obesity in myself, and my daughter for a combined seventy years. There is nothing about obesity that you can tell me that I don’t already know, and kindly get your facts straight, all of them…

Then again to you cull the heard types, you will be very happy to know that my cancer has over come the chemo that I have been taking and is growing anew. Just at the point where I learned enough to may be do something positive about my weight, unless my doctor can do some fancy foot work, and I can stand a hell of a lot of pain, you just may get your wish sooner then I and Natolii would like.
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#18 Schmokie_Dragon

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Posted 11 December 2005 - 09:31 AM

Natolii and emsparks.

No-one here is making blanket statements that ALL people with obesity are AUTOMATICALY responsible for their problem and THEREFORE should be denied treatment. Of course, in a case of extenuating circumstances where people CANNOT lose weight for medical reasons (psychological reasons inclusive) then such a measure would be unfair and draconian.

What is being suggested is that people who CHOSE not to lose weight, who CHOSE to lead deeply unhealthy lives and REFUSE to change their lifestyle, the state has no responsibility to try and fix them when something goes wrong, if it can be proven that it was caused by the lifestyle they love.

I know for a fact that some people cannot control their weight. I feel deeply for such people and hope there may be a resolution to their problem.

I understand how this thread has struck so close to home, but it must be accepted that people need to feel free to discuss moral opinions without it getting personal. If a discussion becomes overly personal, people become obliged to be polite and agree to try and prevent offence, rather than giving a constructive argument.

{{{{{{{Natolii and emsparks}}}}}}}
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#19 Delvo

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Posted 11 December 2005 - 10:06 AM

Schmokie_Dragon, on Dec 11 2005, 09:31 AM, said:

What is being suggested is that people who CHOSE not to lose weight, who CHOSE to lead deeply unhealthy lives and REFUSE to change their lifestyle, the state has no responsibility to try and fix them when something goes wrong, if it can be proven that it was caused by the lifestyle they love.

<{POST_SNAPBACK}>

Then what would be required to make such a system work is a way to separate those who are the cause of their own problems from those who aren't. And if the problem in question is being fat, that policy's troublesome and unfair in more ways than one...

1. It invites fraud by helpful doctors trying to help out their patients by diagnosing them as unable to avoid being fat even if they really could.

2. It means people with any possible unidentified or undiagnosable conditions get lumped in with those who cause their own problems until those conditions are identified and diagnosable.

3. It treats as a dichotomy something that is actually more of a spectrum. The population isn't divided into people who could avoid being fat and people who can't; it's got people in it for whom avoiding being fat comes in varying degrees of difficulty, from "no effort required at all" to "minor effort required" to "substantial sacrifice required" to "could do it but only at such a sacrifice that (s)he'd be miserable as a result", and other possible descriptions somewhere between the above, before you ever get as far as "just plain can't do it". And not only are the causes of obesity non-dichotomous, but so is the condition itself. There are people with some more fat than they should have who aren't rotund and blobbish, and, again, everything between, so you'd have to draw a line somewhere, and wherever you drew it, it wouldn't make sense; if person A were skinny, D were so fat (s)he was practically immobile, and B and C were just a bit below and above the line, you'd end up treating B more like A than like C, and treating C more like D than like B, even though B and C are more similar to each other than either of them is to A or D! Then there's the matter of figuring out precisely how much junk food or how much excercize it takes to cross the "too much/too little" line in either direction, which is worse not only because of the above kind of reason (people do varying amounts of each, not an all-or-nothing kind of thing) but also because one donut eaten or one mile jogged doesn't have the same effects on different people...

* * *

It would make more sense to limit this idea of people having different medical policies based on their behavior to only what they actually do to actively cause a problem rather than what they fail to do to prevent one. Then that policy would catch the drug users but avoid the issue of exactly who or what's at fault in making an overweight person overweight.

But then, that would also include sports as a dangerous thing that tends to cause medical problems, wouldn't it?... at least "extreme sports"... but then do you make a list of which sports are bad and which are good, even though even the good ones still have risk?... and then doesn't such a limiting of options just cause more people to not excercize if the kind of excercize they'd like to do gets blacklisted?...

And let's not even get started on the causes and medical effects of "stress"...

I agree with the concept for the drug users and people who get injured while trying to commit a crime, but the best way to go about it seems to just make the rules be specific about "drug users" and "injuries received in commission of a crime", not something as big and nebulous as "people who contribute to their own medical problems".

#20 emsparks

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Posted 11 December 2005 - 10:14 AM

Schmokie_Dragon, on Dec 11 2005, 10:31 AM, said:


What is being suggested is that people who CHOSE not to lose weight, who CHOSE to lead deeply unhealthy lives and REFUSE to change their lifestyle, the state has no responsibility to try and fix them when something goes wrong, if it can be proven that it was caused by the lifestyle they love.

<{POST_SNAPBACK}>


Dear Schmokie_Dragon,
I don’t know how to respond; with a great deal of respect you don’t understand the problem. The situation with obesity is very complicated, but I must tell you that the number of those that truly choose to be over weight is miniscule if they exist at all. First of all in the medical community there is a raging fight, over what came first, sleep disturbance, or obesity, disturbed sleep is endemic among the obese. Obesity is a super pandemic in developed countries, affecting more and more people each year, with the population percentage currently toping 30%, in the US alone. There are links to electrification and air pollution, being among the causatives. Yes I did say electrification, there are a number of studies, that show, that low intensity magnetic fields, like those emitted by televisions, and high-tension power lines adversely effect human basal metabolism, by reducing it.

Edited by emsparks, 11 December 2005 - 10:15 AM.

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