Monday, April 11, 2005

NHS could refuse patients who will not mend their unhealthy ways

John Ray over at Socialized Medicine has this piece regarding how Britain's National Health Service plans to regulate (SPELLED RATION) access to their healthcare providers:


Patients who refuse to change their unhealthy lifestyles could be refused medical treatment, under proposals from the [U.K.] Government's NHS watchdog. The controversial suggestion from the National Institute of Healthcare and Clinical Excellence would mean that a smoker in need of heart surgery might be denied the operation unless he or she promised to give up the habit.

The proposal is contained in a document which sets out for the first time the social values that should underpin decisions by the institute on which treatments to provide on the NHS.

It says all patients should be treated equally regardless of their age or social responsibilities and rules out discrimination on the grounds of gender, race or socio-economic status.

The only exception should be where a patient's age might affect the chances of success of the treatment. "Health should not be valued more highly in some age groups rather than others," it says. On self inflicted illness - that caused by "unhealthy lifestyles", such as casual sex, smoking, drinking or dangerous sports - it rejects the idea of "deservedness" in deciding who should receive treatment and says it would be impossible in many cases to determine which illnesses were self-inflicted.

It adds: "If the self-inflicted causes of the condition influence the likely outcome ... of an intervention, it may be appropriate to take this into account." A spokesman admitted there was a "grey area" between denying treatment on clinical grounds, because a patient might not benefit from it, and "blackmailing" them to change their behaviour in line with medically accepted health norms.


Remember Adam Smith who said:

"...every individual necessarily labours to render the annual revenue of the society as great as he can. He generally, indeed, neither intends to promote the public interest, nor knows how much he is promoting it. By preferring the support of domestic to that of foreign industry, he intends only his own security; and by directing that industry in such a manner as its produce may be of the greatest value, he intends only his own gain, and he is in this, as in many other cases, led by an invisible hand to promote an end which was no part of his intention. Nor is it always the worse for the society that it was no part of it. By pursuing his own interest he frequently promotes that of the society more effectually than when he really intends to promote it. I have never known much good done by those who affected to trade for the public good."

In this passage, taken from his 1776 book "An Inquiry into the Nature and Causes of the Wealth of Nations" Adam Smith set out the mechanism by which he felt economic society operated. Each individual strives to become wealthy "intending only his own gain" but to this end he must exchange what he owns or produces with others who sufficiently value what he has to offer; in this way, by division of labour and a free market, public interest is advanced.

Smith is often regarded as the father of economics, and his writings have been enormously influential. Nowadays, "invisible hand" explanations are invoked to explain all sorts of phenomena, from scientific progress to environmental degradation. In the modern context, mathematicians study "invisible hand" processes as part of Game Theory, the branch of mathematics that deals with payoffs and strategies (see Game Theory and the Cuban Missile Crisis) in Issue 13 of Plus.

So, what is Britain's excuse?

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