Ethics at interview and the old cigarette

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There are health benefits to skiing, whereas there are pretty much zero benefits for the other two.

Intentional self-harm is usually the result of a mental illness which the patient has no choice over. You don't choose to have the disorder so it would be unjust to determine a person's place in the queue in A&E, for example, because they had just had a cutting episode.

Reply 41

ScheduleII

Original post by boba

I don't know what a GSW is but I would prioritise based on who had the most need. so someone who would otherwise die over someone with a broken hand. or for the same treatment who is likely to respond better. If no judgement cant be made over that (there pretty much equal in both things) it would be first come first serve..

Thank you to NYU'12 for making it clear that prioritising is sometimes unavoidable, it is only a matter of doing so fairly and ethically.

GSW= Gunshot wound. Not quite the same as the difference between gunshot wound and falling over for stitches is not self-infliction as we are discussing but the severity of the problem.

Reply 42

cl_steele

so the fact they [smokers] contribute more to the health service than non smokers has completely passed you by then...?

Reply 43

ScheduleII

Original post by Cherith

Oh, sure, some men have made a very dedicated study of women's health and the surrounding issues. But you aren't an OB/GYN, you aren't a midwife, and you aren't a woman. So what is your claim to expertise?

Interesting straw man with the whole privacy thing. But the actual point is that prevention of pregnancy is a significant part of protecting a woman's health; and since women pay into health insurance, we have a right to receive health care. Birth control is a medically sound option with enormous medical benefits, and I expect it to be covered by the health insurance I pay for. The fact that you pay into the same insurance plan I do does not entitle you to make decisions about my care.

Preventing a RISK to a woman's health from a non-malady, a normal non-pathological state of the female, which is what pregnancy is. Complications are a secondary issue; people take the pill not to prevent a complicated pregnancy with negative health implications for them but because they don't want to be pregnant full stop which is a lifestyle choice. So it's not the same as prophylaxis against infections, which aim to protect from a pathology.

Eating 5 portions of fruit and vegetables a day is "a medically sound option" which helps to prevent diseases, but fruit and veg aren't covered on insurance. Do you not think that the UK system being based so heavily around the State makes a difference? You have a choice whether to take out a particular insurance policy with a private provider, while National Insurance and tax are mandatory. It seems fair the government should not offer services for free without medical necessity, if indeed at all; I don't believe in scrapping the NHS as it would cause too much misery at the present time, although deep down philosophically I wish the government had never got so involved in health it came in 64 years ago and would be wrong to just dismantle.

Reply 44

bornfishy

Original post by ScheduleII

I actually refused to fill in a form at my GP surgery when going in for a prescription for acne medicine asking for my ethnicity, units of alcohol consumed and smoking status and I wrote on the form: I do not wish to disclose my personal lifestyle choices; I have no observable pathology relatable to alcohol or tobacco for which I seek treatment; I am a human being not a statistic to be "equality monitored" or words very close to those, it was last summer.

You're really strange!

Reply 45

cid

fact of the matter is NHS should treat everyone without bias, of course there is professional priority, simple logic dictates the most urgent case should be treated first.

But what is the point of someone contributing to the NHS if they are going to be second class due to their lifestyle choices, I'd rather have the money back from the NHS and spend it on private health cover that would treat me regardless of my lifestyle choices whether it be smoking or wearing a steak suit and poking wolves with a big stick.

Also NHS makes me laugh sometimes, a friend of mine got those pills that do some voodoo mambo jumbo on your brain and get you to quit smoking, i went down to inquire and was told in needed to do a course of nicotine replacement therapy first, i explained i had already tried NRT out of my own pocket (patches/gum/inhalers ... even those electric cigarettes) but I'm still a heavy smoker, but because its not recorded i need to still do it, way to waste money.

Reply 46

DeeWave

As a medical student, I'd answer that question something like this:

"That's a tricky one as there are two sides to it. In principle, I believe everyone should have equal priority for treatment. Regardless of their lifestyle choices, I feel the NHS should be there to help them. Many people would instinctively feel differently if the person in question was a climber who had suffered injury in a mountain fall for example as a result of his lifestyle choices, but in reality it's the same situation. In addition, smokers pay tax on cigarettes which exceeds the cost to the NHS of treating smoking induced illnesses.

"On the other hand, if a patient's lifestyle makes it less likely that a treatment will be successful compared to another patient, then I would consider it fair to prioritise treatment on the basis of clinical efficacy to maximise the potential gain."

There isn't a right or wrong answer as such to ethical questions, but you need to of course show that your attitudes are conducive to being a good doctor. You need to show you can think logically, balance opposing viewpoints and fairly uphold the principles of the profession you seek to be admitted to. There are certain things you could say which would raise fitness to practice issues - and when there are four to seven applicants per place they don't need much of a reason to turn you away.

If you don't feel my argument represents your views, I'd question whether or not medicine is the right choice for you. Even if you can parrot what myself and others have said here and gain a place, if you don't feel that way you will neither enjoy medicine nor become a good doctor.

Reply 47

Annie72

My answer would be that smokers should get exactly the same level of treatment as that of a non smoker.I might be wrong but your own personal view should not come in to it.Put yourself in the shoes of the smoker who in hospital for treatment say for pneumonia along side someone who also has it but has never smoked.Would you say it is fair that the non smoker gets treated first while the smoker has to wait for it?.How would you feel?.

Reply 48

Cherith

Original post by ScheduleII

people take the pill not to prevent a complicated pregnancy with negative health implications for them [...]

You're, well, you're just wrong. You clearly haven't spoken to enough women who nearly died or suffered serious injury from pregnancy or childbirth; I have (and yes, these are women from first-world countries. Childbearing is -- newsflash -- dangerous). You would be shocked at how many women are only preventing pregnancy for their own safety -- and the risks increase with every child. As I said, you're certainly not an expert in women's health . . .

Food isn't a medical treatment; birth control (pills, implant, IUD/IUS, whatever) is. It's not exactly a fuzzy distinction. They have to be dispensed by a doctor. They're medicine.

And the NHS isn't free, as you fully know. It's just an insurance method like any other. I pay into it, and so I expect it to cover the cost of the medical treatment which is required to prevent pregnancy. Because that's why I have health insurance. To cover my healthcare costs. And preventing pregnancy is part of caring for my health. Because pregnancy is a threat to my health. Because it's dangerous. I don't think I can break it down into more basic terms than that.

Also, you should really learn your conservative buzzwords a little bit better. Don't you know that hyperactive preventative medicine is one of the major! advantages! of the American system?

. . . ironically, I'm pregnant with my second child at the moment, so fret not: your hypothetical NI contributions are not providing me with contraception. No, they're providing me with nine months of maternity care instead. Much easier on the budget, eh?

Reply 49

ScheduleII

Original post by DeeWave

I believe everyone should be treated if possible; I just find a philosophy of treatment that does not take into account responsibility for health and the view that no-one should ever have to pay directly for health care to be wrong.

Surely in actual medical practice I wouldn't get to pick which patients I saw? Whoever came to me would receive exactly the same standard of care whether or not I believe they are responsible, moral or anything else.

It's only from a purely abstract perspective I believe that mainly private medicine is morally superior to socialised medicine. This would not disqualify me from working under a socialised system: there was a teacher at my school who believed in restoring the tripartite system as do I. She still did her job properly and professionally in a comprehensive school.

Reply 50

Annie72

I can totally see your point because the smoker will only keep smoking and therefore ruin the donated lungs, but I felt that the OP was being an arse about the priority thing.I dont think that OP will even pass the interview,never mind actually become a Dr.

Reply 51

DeeWave

Original post by ScheduleII

That's where many in the profession would disagree. Many (including me) would say that any patient deserves an equal access to treatment, regardless of whether or not their actions could be considered to have caused their illness.

Of course you wouldn't deliberately treat smokers worse, but issues arise where there is limited resource allocation: money for drugs or surgery, availability of donor organs etc.

It generally isn't considered right to express prejudice - but it is a different issue if a person's lifestyle will affect the outcome of a treatment. Most doctors wouldn't be happy giving a liver transplant to someone continuing to abuse alcohol, for instance, because it probably wouldn't succeed. But if the patient had reformed, they should then have an equal right to treatment in the view of many, regardless of the fact that their irresponsible behaviour caused the problem initially. That is the difference.

Out of interest, what do you feel about:

- Expensive air ambulances to airlift injured climbers to hospital who have fallen on mountains?

- Knee replacements for keen runners?

- Surgery for racing drivers injured in on-track collisions?

Reply 52

Toaster Leavings

It wouldn't decrease the amount of smokers. Everyone knows the health implications and yet they still do it. Surely knowing you could face severe pain through COPD or lung cancer would be enough to put anyone off if they were making the choice based on health reasons. It's not like you think, oh well I'll smoke and get lung cancer and be in severe pain but the NHS might give me a lung transplant so it'll all be ok. That's not the mindset is it? It's just a case of not caring enough or not thinking about the health implications at all.

So, you're not going to encourage responsibility with that move.

Reply 53

Dwayne Hicks

You don't sound like your going to make an empathetic doctor with such selfish views.

Reply 54

LPScot

Original post by cl_steele

so the fact they [smokers] contribute more to the health service than non smokers has completely passed you by then...?

Sorry in advance if I've completely misunderstood your comment.. But is your point that because smokers buy cigarettes and therefore pay tax on those cigarettes they are essentially paying more towards the NHS than non-smokers and are therefore more 'deserving' of treatment?

Reply 55

ScheduleII

Original post by Dwayne Hicks

You don't sound like your going to make an empathetic doctor with such selfish views.

I would still be empathetic. It's the fact that one person has to be treated before the other in that question, so you need to decide who.Choosing the non-smoker is not selfish unless you do it because you are a private clinician and you think the n/s will live longer to pay you for follow-ups, or you are worried about the impact operating on a smoker who is unlikely to have a favourable outcome will have on your own reputation.

Do NICE and the clinicians who advise them have no empathy when they fail to approve a drug for NHS prescribing on cost grounds? They are deciding how to fairly allocate finite resources, through QALYs and similar systems. They aren't deciding "we have no sympathy for these people so put them to the back of the queue."

Reply 56

cl_steele

Original post by LPScot

the point i was making was that smokers should be treated equally to non smokers in the eyes of the NHS, not with any prefference of course not but i was saying that whilst it may be their fault for the illness they have through smoking they make up for that fact with the rivers of cash that are taken in through tax, but no sorry if it came across that i meant they should be given preferential treatment, of course not :smile:

Reply 57

Orinincandenza

Original post by ScheduleII

Well I don't see it as "wrong" to prioritise people whose condition is not mainly their fault as more deserving (the outcomes are better for patients with healthy lifestyles anyway if that is what you think priority should be based on; I find it too simplistic not to consider desert) , or expect the smoker to make an affordable financial contribution to their healthcare.

It seems a lot of people do from the negs I've been hit with.... The last time I got a line of negs on the Medicine forum was for opposing abortion. Conservatives really get it in the neck here.

Erm, right, i'm not sure you've quite got my point or not here, just to be clear, it was that regardless of personal opinion, you have to be able to accept the mainstream view to become a successful professional, especially in medicine. If a doctor suddenly woke up and decided he didn't want to treat Jewish people anymore, he wouldn't keep his job for very long. I'm not saying your opinion is comparable to racism but it is pretty far from the commonly held view.

Furthermore simply claiming that people don't agree with you because of some imagined liberal-conservative divide is ludicrous and does nothing to help the debate. W/R/T abortion that's not a liberal-conservative argument. It's the law in the UK, all mainstream politicians and 99% of doctors support it, to come out against it is a fringe view.

To be Honest i don't think either of the extremes are right, like most ethical dilemmas you have to find a balance. You can't not treat someone because of a 'self-inflicted' condition but equally you give someone a new liver transplant if you know that they'll ruin it with alcohol and you have other people in need who wouldn't.

Reply 58

ScheduleII

Original post by Orinincandenza

I will not agree with something just because it's legal in the UK. My morals are not related to UK laws in the slightest. The law tells me if I can be punished for doing something or not, it can't tell me whether it's right or wrong. It is as simple as that.

I believe that human life should be protected from conception (i.e. sperm joining with egg, not the blastocyst implanting) and so morally abortion is murder; therefore all abortifacients should be banned including the morning-after pill. I supported the Personhood Amendment in Mississippi last autumn (unfortunately it got voted down 57%-43%) which would have criminalised all killing of unborn children. I will not support any means of killing a child before birth unless it is the only way of saving the mother's life, which is extremely rare. Even babies with abnormalities and babies conceived in rape do not deserve death.

99% of doctors support abortion? Where did you get that from? 75% of the public are "pro-choice" according to the largest recent survey, but I am not sure what pro-choice means: that it's morally right, that it's morally wrong but should remain legal so other people can have a choice, that it's morally wrong but criminalising it would cause more problems for individuals and society so pragmatically it should stay legal, or that in certain circumstances (rape, very young age of mother, foetal abnormality, baby would be brought into abusive environment, mother with health problems that make being pregnant a bigger risk for her etc) but wrong in others. It is most definitely not a "fringe position" that abortions without good justification are wrong. In any case I will not just follow the multitude. Morality is not decided by majority vote.

It IS a conservative/liberal issue, but social conservative, not fiscal (which is what the UK Conservative Party is more into.) Frank Field is a Labour MP and left-wing fiscally but is very much pro-life and pro-family. I am a "movement conservative", consistent across a wide range of social and fiscal issues.
Although I am uncompromising on killing the preborn, I do have a balanced view on self-inflicted illnesses. The whole thing about not treating Jews is a red herring because I would not refuse to treat anyone, nor do I believe that smokers do not "merit" treatment. It is purely a matter of priority.