Should the nhs pay for lifestyle related diseases?
I am doing some research about the topic above and I think this is an important topic nowadays especially we are in crisis economically. However there are different opinions out there so I guess I just want to hear everyone's opinion!
Thank you
Thank you
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The thing is, isn't almost everything a "lifestyle related disease?" - cancer, heart disease, broken bones, etc. To make matters worse, we don't even know all of the factors which might increase the chances of certain diseases and we don't know by how much.
Original post by PicardianSocialist
The thing is, isn't almost everything a "lifestyle related disease?" - cancer, heart disease, broken bones, etc. To make matters worse, we don't even know all of the factors which might increase the chances of certain diseases and we don't know by how much.
I was going to say pretty much the same. Go onto any ward in a hospital and there will be an element of lifestyle causes to a vast majority of conditions you encounter.
I think in some cases, for example transplants, lifestyle choices are taken into account? I seem to remember reading something about lung transplants and smoking but don't hold me to it. I agree with the previous posts about "lifestyle related" being a very grey area. The idea of turning people away is also problematic because who would make those decisions and under what criteria? I think with particularly evident examples of lifestyle choices leading to diseases, education should instead be invested in to tackle them before they begin, as opposed to refusing the individuals medical treatment if they need it.
Yes, they should. Our lifestyles contribute to a plethora of conditions: Cancer, organ failure, mobility problems, and many more. Would cost far too much time and money to factor the lifestyle of every patient; money that perhaps would serve a better use pumped into the system.
The one distinction I would make is that those who are in fault (consistent drinkers, smokers etc) should be moved down in the transplant list when in competition with those of similar severity who didn't make the same choices.
The one distinction I would make is that those who are in fault (consistent drinkers, smokers etc) should be moved down in the transplant list when in competition with those of similar severity who didn't make the same choices.
(edited 10 years ago)
Original post by Pedd
The one distinction I would make is that those who are in fault (consistent drinkers, smokers etc) should be moved down in the transplant list when in competition with those of similar severity who didn't make the same choices.
Drinkers and smokers don't qualify for transplants.
Original post by moonkatt
Drinkers and smokers don't qualify for transplants.
This guy would disagree (George Best)
(edited 10 years ago)
Original post by OedipusTheKing
This guy would disagree (George Best)
This guy would disagree (George Best)
He was an anomaly, I look after transplant patients regularly and one of the many criteria they have to meet is abstinence from alcohol.
Original post by moonkatt
He was an anomaly, I look after transplant patients regularly and one of the many criteria they have to meet is abstinence from alcohol.
I know, I was just throwing it out there
I wonder why he was an exception.
There is an aspect of lifestyle somewhere in rather more accidents and illnesses than one might think, at first thought.
Claim dep: I understand you were in a road accident, while on a motorbike? Ooh, shouldn't have been on a motorbike, should you? What's that? The other driver was at fault and you work as a motorcycle courier? Well, you still knew it was a significant risk.
<next call>
Claim dep: No, we don't pay out for heart disease. Yes, I understand that you have a genetic predisposition to heart disease, but studies show that 5% of people with this gene don't go on to develop heart disease,. Further studies have shown that the difference between the 95% who need life-saving medical treatment and the 5% who don't is the latter's adherence to a healthy lifestyle.
Claim dep; your toddler fell down the stairs and broke his arm? Should have had a stair gate.
Claim dep: pregnancy complications? Well, you either chose to have a baby, or you chose not to terminate.
Where would you draw the line? Wherever we drew it, we would need to create a huge bureaucracy to deal with it, especially if you want any kind of "fairness".
The other issue is that for many illnesses, treatment is rather cheaper, the earlier the patient presents themselves. If you try to save money by discouraging people from making visits to the doctor, the savings are more than cancelled out when patients eventually turn up with seriously progressed diseases.
Claim dep: I understand you were in a road accident, while on a motorbike? Ooh, shouldn't have been on a motorbike, should you? What's that? The other driver was at fault and you work as a motorcycle courier? Well, you still knew it was a significant risk.
<next call>
Claim dep: No, we don't pay out for heart disease. Yes, I understand that you have a genetic predisposition to heart disease, but studies show that 5% of people with this gene don't go on to develop heart disease,. Further studies have shown that the difference between the 95% who need life-saving medical treatment and the 5% who don't is the latter's adherence to a healthy lifestyle.
Claim dep; your toddler fell down the stairs and broke his arm? Should have had a stair gate.
Claim dep: pregnancy complications? Well, you either chose to have a baby, or you chose not to terminate.
Where would you draw the line? Wherever we drew it, we would need to create a huge bureaucracy to deal with it, especially if you want any kind of "fairness".
The other issue is that for many illnesses, treatment is rather cheaper, the earlier the patient presents themselves. If you try to save money by discouraging people from making visits to the doctor, the savings are more than cancelled out when patients eventually turn up with seriously progressed diseases.
Ask yourself whether you want to live in a society that forces people with cancer to die in unimaginable pain without treatment in their own homes. I don't. If I wanted to live in the Sudan I would.
If you talk about lifestyle related diseases, why not lifestyle related injuries? Should the NHS be burdened with treating people who get injured pursuing dangerous sports or occupations?
It's a bit of a slippery slope.
And once you start moralizing about healthcare someone is inevitibly going to have to play God and decide "this person is more worthy than that person so this person gets a lung transplant and that person gets an unimaginably painful death without treatment" Who's going to make those decisions?
It can always be argued that smokers (for example) should pay a premium for healthcare. That's a fair argument. But then again, they already do since the tax on tobbaco pays for the entire NHS several times over. So, tongue in cheek, should smokers be subsidizing healthcare for the rest of us?!
And what was the original purpose of the NHS? It was meant as a great social and inclusive reform. Bevan, was a lifelong champion of social justice and the rights of working people. He would never have envisaged his creation coming under the exclusive ownership of the healthy middle classes! To turn away those made ill through "lifestyle choice" spits on the man's memory.
Such an action would also be an indirect war on the working classes and poor (War on the single mothers) because it's the poor that make the worst lifestyle choices. Again, Bevan would spin in his grave.
So treat one, treat all.
If you talk about lifestyle related diseases, why not lifestyle related injuries? Should the NHS be burdened with treating people who get injured pursuing dangerous sports or occupations?
It's a bit of a slippery slope.
And once you start moralizing about healthcare someone is inevitibly going to have to play God and decide "this person is more worthy than that person so this person gets a lung transplant and that person gets an unimaginably painful death without treatment" Who's going to make those decisions?
It can always be argued that smokers (for example) should pay a premium for healthcare. That's a fair argument. But then again, they already do since the tax on tobbaco pays for the entire NHS several times over. So, tongue in cheek, should smokers be subsidizing healthcare for the rest of us?!
And what was the original purpose of the NHS? It was meant as a great social and inclusive reform. Bevan, was a lifelong champion of social justice and the rights of working people. He would never have envisaged his creation coming under the exclusive ownership of the healthy middle classes! To turn away those made ill through "lifestyle choice" spits on the man's memory.
Such an action would also be an indirect war on the working classes and poor (War on the single mothers) because it's the poor that make the worst lifestyle choices. Again, Bevan would spin in his grave.
So treat one, treat all.
I think it would be difficult to determine and justify what counts as 'lifestyle'. Even something like playing sport (which I think we'd all agree should be encouraged) will increase your risk of breaking/straining/tearing something. Perhaps we could determine what lifestyle choices are 'bad' and demand payment for injuries/illnesses caused by those (smoking, drinking), but even then we run the risk of hurting already vulnerable groups such as druggies who won't be able to afford treatment.
Yes. Who are we to tell others how to live their lives?
And where would you draw the line?
Forcing car crash victims to pay because driving was their lifestyle choice?
Medicine's about being non-judgemental, creating a system for people to be judged completely goes against any doctor's ethical standards.
And where would you draw the line?
Forcing car crash victims to pay because driving was their lifestyle choice?
Medicine's about being non-judgemental, creating a system for people to be judged completely goes against any doctor's ethical standards.
Original post by moonkatt
He was an anomaly, I look after transplant patients regularly and one of the many criteria they have to meet is abstinence from alcohol.
Can I ask how you prove such a thing?
Original post by de_monies
Can I ask how you prove such a thing?
Ok, I've had a look about, for liver transplantation, active drinking is an absolute contraindication for having a transplant under NHSBT rules. I think with kidneys it is a relative contraindication, however there are so many people waiting for organs that if a panel has to chose between someone who is a drinker and who isn't then who do you think they would select.
I'll try and find the link for this stuff.
Here we go:
6.2 Alcohol use
Allocation of donated organs to those who have organ damage as a consequence of excess alcohol use is controversial and, in general, not supported by the public (as evidenced by public opinion surveys). However, outcomes of selected patients with alcohol-induced liver damage are at least as good as for other indications so it is
important that these patients are treated fairly.
Different conditions may apply when alcohol use has contributed significantly to the organ failure, compared with concerns about alcohol use without organ damage. Where the MDT has concerns that the potential candidate is either abusing or dependent on alcohol, there should be a full assessment by clinicians expert in the field of alcohol abuse. The specialists should assess the background, treatments offered and accepted, the likely outcome after transplantation, and the support required to ensure the recipient complies with medical advice
Allocation of donated organs to those who have organ damage as a consequence of excess alcohol use is controversial and, in general, not supported by the public (as evidenced by public opinion surveys). However, outcomes of selected patients with alcohol-induced liver damage are at least as good as for other indications so it is
important that these patients are treated fairly.
Different conditions may apply when alcohol use has contributed significantly to the organ failure, compared with concerns about alcohol use without organ damage. Where the MDT has concerns that the potential candidate is either abusing or dependent on alcohol, there should be a full assessment by clinicians expert in the field of alcohol abuse. The specialists should assess the background, treatments offered and accepted, the likely outcome after transplantation, and the support required to ensure the recipient complies with medical advice
http://www.odt.nhs.uk/pdf/introduction_to_selection_and_allocation_policies.pdf
So not as clear cut as I first said, but it's unlikely someone actively misusing alcohol would end up receiving a donated organ.
(edited 10 years ago)
Original post by moonkatt
Ok, I've had a look about, for liver transplantation, active drinking is an absolute contraindication for having a transplant under NHSBT rules. I think with kidneys it is a relative contraindication, however there are so many people waiting for organs that if a panel has to chose between someone who is a drinker and who isn't then who do you think they would select.
I'll try and find the link for this stuff.
I'll try and find the link for this stuff.
Hmm fair enoughs. Well, good thing I don't drink or smoke then
But my question was more how you would prove such a thing. With smoking there's obvious indicators, but with alcohol, there isn't normally?Original post by de_monies
Hmm fair enoughs. Well, good thing I don't drink or smoke then But my question was more how you would prove such a thing. With smoking there's obvious indicators, but with alcohol, there isn't normally?
But my question was more how you would prove such a thing. With smoking there's obvious indicators, but with alcohol, there isn't normally?Liver function tests and they're assessed by a psychiatrist specialising in addictions.
Original post by moonkatt
Liver function tests and they're assessed by a psychiatrist specialising in addictions.
Ah cool. That seems pretty interesting and cool
I would simply argue yes. The NHS should be ruled by a need to punish people who live damaging lifestyles. As has already been said, many lifestyles damage our lives, aside from the obvious alcohol and tobacco.
With smoking and drinking both being legal, I think it is completely immoral to deny treatment or transplants based on whether the person drinks or smokes. Especially with such a large percentage of people drinking, and it being so heavily endorsed by our culture.
I do however, think there are practical limitations, and treatment should be directed to where it can do the most good. A person who is unwilling to change their lifestyle should still be entitled to treatment, but should be a lower priority than someone who is willing to change their lifestyle, or who has a disease unrelated to their lifestyle.
Frankly, if we are going to deny treatment to lifestyles, then those lifestyles should be illegal.
With smoking and drinking both being legal, I think it is completely immoral to deny treatment or transplants based on whether the person drinks or smokes. Especially with such a large percentage of people drinking, and it being so heavily endorsed by our culture.
I do however, think there are practical limitations, and treatment should be directed to where it can do the most good. A person who is unwilling to change their lifestyle should still be entitled to treatment, but should be a lower priority than someone who is willing to change their lifestyle, or who has a disease unrelated to their lifestyle.
Frankly, if we are going to deny treatment to lifestyles, then those lifestyles should be illegal.
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