Saturday, October 15, 2011

Ethics: Would you save the life of a smoker?

I know a fair few medics and as a quasi-trained medic myself I was reflecting on this question. Fairly recently the NHS (National Health Service) in the UK said that it would not provide hip replacements to those that were obese under the NHS (they would have to pay for it themselves) and it got me thinking. Should a health service use it's time and resources dealing with 'self inflicted' conditions? I also am aware that all medics take an oath, but we are going to pretend that the oath doesn't apply here purely for the debate.

The debate is really thus:

- Smokers inflict harm on themselves by smoking, in full knowledge that it will cause them massive harm in later life yet they still keep going

- Public knowledge of this is great and there are even government sponsored schemes in many countries to get people off cigarettes

- Smokers tie up beds and other scarce resources in hospitals that could be used by others, especially in government hospitals

- If a smoker were to come in to A&E (Accident and Emergency, for Americans that is ER) for a smoking related condition then they are still eligible for emergency treatment even if there are other 'genuinely' injured patients there

- Most if not all smokers will end up in hospital over a smoking related illness at some point, often a government hospital which again ties up resources from 'genuinely' injured people

I must say that I lose a lot of respect for someone once I find they smoke and a I'm quite up front in telling them how stupid I think they are (I often point out that jumping off a bridge is cheaper if they really want to commit suicide). In my opinion there is absolutely no reason why someone should smoke and it's a sign of weakness. That said I am also very quick to offer my support if they want to quit. Thus in this debate I am heavily biased towards not treating smokers for conditions they have 'inflicted' upon themselves.

That is really the crux of it for me. Why should an over stressed, massively over worked government paid surgeon have to spend his or her time operating on someone who is only really on his or her operating table becuase of stupidity? Especially if said smoker is likely to go out and smoke again. Let me add however I have great friends who do smoke and I'd probably be devastated if they were to die.

I'm really for the overall banning of cigarettes and smoking. My argument is that there is no reason for them to be here. If they were invented yesterday do you think that they would be allowed on the market?! For me the issue of 'right to chose' doesn't come into this. If someone has a right to chose to smoke, shouldn't the health service have a 'right to chose' not to treat them for their self inflicted injury?

The other argument often called against me is that smokers put a lot of tax revenue into the treasury. This, for me, is really the only reason smoking still exists and governments don't have the guts to ban it; a strong tobacco lobby and cash in the coffers. But really, how much do they put in? And then how much is taken out again to have to pay for their treatments?

We're sliding away from the topic at hand here, we are not talking about banning smoking. We are talking about treating self inflicted conditions and here is where it get's a bit messy. Becuase there are other self inflicted conditions.

For example, if a drunk driver crashes his car because he is drunk should he be treated? After all, his drunkenness caused the accident. What about a woman that threw herself off a bridge? Again, she did it to herself.

I think it is fair to say that in both of these cases most would say they should be treated. But why? Is it any different to the smoker? They caused their situations didn't they? Again, it's messy but I do think there is a difference. Because in both cases they are really 'one time' instances, not brought on by years of self abuse.

This is especially true of the woman who jumped off a bridge as it is highly likely that she did it for a reason such as depression. And depression, by and large, isn't a self inflicted condition or one that you pick up on purpose. This I feel is the difference when compared to smoking. She made a mistake in all probability, shouldn't she be given another chance? I feel that she should.

But what about a smoker? Shouldn't they get another chance? Actually, I feel they have already don't you? It tends to take years before smoking will end with you in a hospital, so a smoker had years of chances to alleviate their condition.

In the end however, I feel that most doctors will, quite rightly, feel strongly against not saving a life if they can. Even me, with my loathing of smoking, would probably feel the same in the situation. But it's a tough topic and one that in a world where health budgets are being slashed will surely come up. We'll be back on this topic with certainty.

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