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That's no way to treat the sick

Hasan Suroor

Doctors refusing to treat the sick, regardless of the reasons, is seen to be a case of carrying moral policing too far.

CAN DOCTORS refuse to treat patients suffering from what they regard as "self-inflicting" illnesses such as those caused by drinking, smoking or simply eating too much? The answer seems to be "yes" if the money for the treatment is coming from state coffers, and the public health service is as over-stretched as it is in Britain.

The new "mantra" is to hold people themselves responsible for their health and penalise those who refuse to kick unhealthy habits. Britons have been warned that if they smoke or drink or eat fattening food, ignoring health warnings, they should not expect the state to pay for their "self-inflicted" distress. This from a government that has liberalised drinking laws by allowing pubs to remain open beyond midnight, and whose almost first act after coming to power in 1997 was to allow tobacco companies to sponsor Formula One car racing.

But, as they say, that was then; this is now. And signs are that the campaign to reform "persistent [health] offenders" is already in full swing.

Recently, in a judgment that had smokers up in arms, the High Court ruled that they were legally responsible for their own ill-health, and this week a new controversy erupted after a government surgeon refused to even examine a patient with a potentially crippling condition, known as "claudication" apparently caused by smoking. The disease which results in blocked arteries, if not treated in time, can leave the patient permanently confined to the wheelchair.

But the surgeon made clear that it was not his policy to "investigate or treat" people suffering from this particular type of illness unless they first gave up smoking. "I do not in any way investigate or treat claudication while they [its victims] smoke. I would suggest you encourage they give up the habit completely. When they have been off cigarettes for six months, re-refer if symptoms persist," Andrew Lamerton, a surgeon at Lincoln County Hospital, wrote to the patient's family doctor.

Dr. Lamerton's stance was justified by his hospital, which said it was intended to "ease pressure on outpatient time and avoid the patient making an unnecessary journey."

The patient, Frederick Smith, confessed that he was a heavy smoker but argued that as a taxpayer he had a right to be seen by a doctor, irrespective of what caused his condition. "This man has never even seen me, so he doesn't know what is causing the problem. It might be smoking but it might not be. But this man just doesn't want to know. He has never met me, but he has the effrontery to say he doesn't want to treat me just because I smoke. As a taxpayer I've helped pay his wages and train him. Now he's paying me back by using bullying tactics," an angry Mr. Smith told The Times.

Although there is no official policy yet on doctors not seeing patients stricken with "self-inflicted" illnesses, the Government is said to be quietly supportive of any approach likely to relieve pressure on its resources.

Not a day passes without Ministers and government health advisers expressing concern that people with obesity, alcoholism, smoking, and drug-related problems are a huge drain on the National Health Service and the taxpayers' money.

Alarming headlines about how much such people cost the exchequer have become the stuff of daily news since the Blair Government launched a massive campaign to discourage unhealthy lifestyles that could eventually add to the strain on a creaking NHS. The argument on the other side is that the patients too pay taxes and contribute specifically to the NHS through national insurance and are, therefore, entitled to treatment. "If smokers are refused treatment, they should get their money back — and if that happened it would mean the end of the NHS as we know it," said a spokesman of the Organisation for the Right to Enjoy Smoking Tobacco.

Ethical issue

Critics say that irrespective of the merit of the Lamerton-Smith case (some believe that the surgeon was right in refusing to operate in a condition which might automatically improve if the patient gave up smoking), there are ethical issues involved here. Medical ethics, they say, require doctors to treat anyone who is in pain no matter what caused the pain. The very notion of "self-inflicting" illnesses is seen to be faintly absurd.

The most obvious case of a "self-inflicted" condition, it is pointed out, is attempted suicide. So, does it mean that doctors would stop treating suicide cases? Or that diabetic patients would be left to fend for themselves if doctors believe they brought it upon themselves by consuming sugar-rich diet? Or are they going to tell a heart patient that they would not treat him because it is his lifestyle that is responsible for his illness? "Where is it going to stop," asked one commentator.

There is widespread support for the Government's efforts to create public awareness on health issues, and even coercive measures such as the proposed public ban on smoking have gone down well. But for doctors to refuse to treat the sick, regardless of the reasons, is seen to be carrying moral policing too far.

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