The Guardian reports a poll among doctors which shows some questionable attitudes:
Smokers who need heart bypasses and alcoholics who need liver transplants should not get them free on the NHS, according to four out of 10 hospital doctors. A quarter of those questioned in a survey also believe obese patients should not be given free anti-obesity drugs or receive free orthopaedic treatments.There are various reasons why we might think that heavy smokers and drinkers and eaters shouldn't receive NHS treatment for the illnesses they contract. One is that medical treatment is less likely to succeed with them, and if that's true, it's hard to deny that it makes a difference as to whether they should get the treatment rather than other patients who would do better. In health care as elsewhere resources are scarce, and it seems reasonable to use them where they're most likely to work. But another reason is often cited, and that's the thought that these people have brought their own illnesses on themselves, and hence should take second place to patients who are innocent, so to speak, in that their behaviour and choices haven't contributed to their own disease. The smokers etc don't deserve to get the treatment ahead of more prudent patients who've looked after themselves properly.
But there's a real problem with this view. Smokers and drinkers and overweight people aren't the only ones who contribute to their own ill-health. What about mountain-climbers? Are we to refuse NHS treatment to them for the injuries they incur when they fall off their beloved mountains? And there are also sportsmen and women, whose joints in later life may well give disproportionate trouble – should they take second place (or 20th place) behind those who prudently stayed home and watched telly? What about bad-tempered people who contribute to their own high blood pressure? And then there are drivers – well, they didn't have to drive themselves around, did they? It would have been safer to leave the driving to the professionals and take the bus...
So that's one problem with denying NHS treatment to people who bring their own diseases on themselves: it's going to be quite hard to know who to put into that category, and it may turn out to include a lot of us. Furthermore, it's worth noting that smokers and drinkers and people who over-eat are often people who pay a great deal in taxation – many of them are net contributors to the tax base even after all their medical treatments are taken into account (especially since they tend to die early and not draw their pensions).
There are two other reasons that should be taken into consideration. First, denying NHS treatment because the patient brought her own disease on herself amounts to saying that she doesn't deserve the treatment as much as the more prudent patient. And some people feel that it's not the business of health care professionals to be deciding which patient is a deserving one and which isn't. These are moral judgements which fall outside the area of medical expertise, and there's no reason to think that doctors are the right people to make them.
Second, behind that first reason there lies a deeper one: many of us feel that there's something special about health care, something suggesting that we should offer it impartially to everyone, no matter what they deserve or don't deserve. The thought here is that we all have a profound need for health care, since without it most of the other things we want won't be, or will be less, available to us, and at some points that may include life itself. We should, so it is felt, offer health care without discrimination to all members of society – it's too important a service to withhold from anyone. This seems to express a kind of solidarity with our fellows regardless of their moral, or any other, status: a solidarity based purely on common human needs. That impulse of solidarity is not something we should lightly dismiss. (Eve Garrard)