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Who deserves health care?

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Who deserves health care? Rebecca O'Donovan In today's National Health Service, there are more patients than there are resources to treat them. Therefore, the treatment patients receive is on a priority basis and this is assessed according to the patients' need, how ill they are, how they will respond to the treatment and how much their quality of life will be improved following the treatment. In effect the NHS adopts a utilitarian stance when treating patients as it aims to do the greatest good for the greatest number. In order to do this each patient requiring expensive treatment is assessed according to a quality adjusted life years (QALY) score´┐Ż. This is an equation that measures all of the aforementioned criteria and is used to assess the cost versus benefit of a particular treatment. If a patients quality of life would improve greatly and the cost of the treatment is low then the QALY score will be high. However, if the benefit to quality of life is high but the treatment is expensive then the score will be low. This tool is useful to a degree in assisting doctors who are trying to decide how to allocate limited resources but it discriminates against certain groups. For instance those patients who are elderly and need a hip operation for example will have a low QALY score because they have fewer quality of life years left to live than somebody in their fifties needing a coronary artery bypass graft (CABG) operation. In this scenario the person needing the bypass operation is likely to be overweight and, or a smoker and could be considered to be responsible for their illness. Yet due to the improvement of quality life this person is likely to gain, they will have the operation instead of the elderly patient as they will achieve a higher QALY score. This seems rather unfair and raises the question should people who are responsible for their own illness get priority for treatment over those who are not regardless of their QALY score? ...read more.


However, put aside the need of other patients and now concentrate on the issue of giving an organ to a patient who has created their own health problems. In the case of smokers, they often receive transplants and operations without having to abstain from smoking although some doctors ask them to try to give up after the operation once the treatment is complete; they are free to carry on with the behaviour that necessitated the treatment in the first instance. Alcoholics however, do not get the same unconditional access to treatment. They must show that they can refrain from drinking alcohol for a significant period of time before they will be considered for a transplant7. This could be because it must be considered whether or not the patient can abstain from alcohol following the transplant. It would be a waste of resources to remove an alcohol damaged liver and replace it with a healthy one only for that to become damaged too. It would also be unfair to patients on the transplant list who would look after the organ but surely this is also true for smokers on the CABG waiting list. Taking that into consideration, there are patients who have abstained from drinking alcohol but do not receive transplants due to their poor prognosis. However, Ubel (1997) claims there is data to indicate that people who are carefully selected for liver transplantation actually have a good prognosis that is similar to that of a person who is receiving a liver transplant for other reasons7. Yet few of these patients receive transplants quickly if at all. It could be concluded that this is because doctors and transplant coordinators feel that an alcoholics health problems are their own fault and that the NHS should not be required to foot the bill and therefore, feel that retributive justice is appropriate. Society could argue that they should not have to pay for these people to stop drinking as they choose to start. ...read more.


Whilst health care professionals have a duty to care for patients regardless of how it came to be that they required medical treatment, with only finite resources surely it would be fair to treat those who are the most deserving. People who smoke had a choice when they started and they have a choice about giving up. Those people who are obese (not as a symptom of a metabolic or genetic disease) are aware of the health risks and whilst there is debate about whether obesity is an eating disorder for some, it is not the case for everybody and so valuable resources are used to treat those who have indulged themselves. Then there is the case of those people with Down's who are considered to have a poor quality of life and are therefore, less deserving of treatment. However, taking all things as being equal then those with Down's have a good quality of life it is just different to others and therefore, not grounds to deny people the chance to carry on living life. I appreciate that once treated people that smoke or are obese are more productive members of society than those with Down's Syndrome, however, if they did not smoke or over indulge this would not be an issue as they would not require treatment and those who were not in anyway responsible for their disease would always get priority. Whilst we cannot force people to give up bad habits, we should not reward them either. The NHS cannot adopt a retributive care system; however it could treat patients more equally. It has already been mentioned that in order for alcoholics to be considered for transplantation they need to abstain from alcohol for a period of time, this notion should be adopted for smokers and those suffering from obesity. Should patients from any of these groups satisfy that criteria, then treatment should be carried out but those who are unwilling to help themselves or do not have the will power should not be given access to procedures such as CABG when there are people more deserving of finite resources. ...read more.

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