Oxford Debates – The NHS should not treat self-inflicted illness (Moderator’s Introduction)

Moderator: Dr Paula Boddington

Should the NHS treat self-inflicted illness? This question raises a plethora of different issues, about science, society, social policy, as well as philosophical questions about human nature and individual freedom.

The best use of health care resources will always be debated. How much money should be spent on health? How efficiently can it be spent? How should it be divided within the healthcare system? These can never simply be questions of economics but also raise vitally important questions about values. This debate about what treatments the NHS should offer is taking place in an economic climate where there is a call to curtail public spending. Would refusing to treat self-inflicted illnesses be a fair place to start to save money?

But money is only one aspect of this debate.

This debate as framed is not just a general debate about the treatment of certain types of illness, but as one about a particular health care service: the much loved, much debated, long suffering NHS. The debate raises the wider question of what the NHS stands for, and what role it should have in society, what it is fair to expect from the NHS, and what individuals should do in return. It raises questions about living in a liberal society, about the rights and responsibilities that each of us has in such a society and how free we should be to live the lives we choose. There are many voices urging us to take responsibility for our own health – from food labelling, advice about alcohol consumption, exercise and obesity, to legislation restricting smoking. Calls for greater responsibility can easily seem, on the one hand, calls to treat people like sensible adults in charge of their own lives, yet on the other hand as unfairly apportioning blame.

Questions of scientific evidence are centrally involved in this debate, yet crucially these questions are interlaced with wider meanings and values. One question is whether or not the evidence can demonstrate that certain conditions are caused by aspects of a person’s own behaviour. A further question, however, concerns the roots of our behaviour and of our notions of individual responsibility. Can we find biological or social causes underlying individual behaviours that may help us to answer the question of to what extent individuals should be seen as having responsibility for their actions?

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