Oxford Debates Cont’d – Opposer’s Closing Statement

Part of the debate "The NHS should not treat self-inflicted illness"

Opposer: Charles Foster
Closing Statement

The criterion 'self-inflicted' is unworkable in practice. One simply does not know in many cases whether a particular disease or injury is self-inflicted. Yes, there is ample evidence to show that smoking can cause lung cancer. But some lung cancers are not caused by smoking. How can medical decision-makers decide in the case of Patient A, a smoker, that her cancer is a result of her smoking?  Such matters of medical causation are notoriously hard to resolve even in the courts, with the luxury of expert evidence, unlimited time and prolonged argument from counsel.
Many illnesses are caused by a (generally mysterious) interaction of genes and environment. How does Dr. Sheehan take account of the genetic contribution? Suppose that Patient B has a familial predisposition to high cholesterol. She only discovered this in her thirties. Until then she ate a diet that would be fine in someone without her predisposition, but is dangerous in her case. She gets atherosclerosis and needs a coronary stent. Should she have one? Is her condition self-inflicted? Would Dr. Sheehan's decision about her treatment depend on whether she should, with the exercise of appropriate care (what's 'appropriate'?), have cut down on the pies earlier than she did? These questions are horrifically difficult. We can multiply them ad nauseam. They are all raised by Dr. Sheehan's purportedly straightforward criterion.

Dr. Sheehan's motion presumably seeks to encourage the sort of behaviour that he regards as responsible (by which he means 'in accordance with the prevailing medical wisdom'). That in itself would be a laudable objective if one could have any confidence that today's medical orthodoxy would not be tomorrow's heresy. But the application of his criterion will often penalise people who have done the 'right thing'. Suppose that one could decide with medical certainty that X's cancer was caused by her smoking. Let's say that she had given up smoking, after a heroic struggle, 10 years before. The cigarettes had nonetheless got her in the end. Dr. Sheehan's icy judgment would be: 'No treatment'. Is that right?

Society (of which the NHS is an important expression), is at least arguably responsible for many of the problems that Dr. Sheehan would label 'self-inflicted.'

We should judge a society by the way it treats its most vulnerable. We all make mistakes. A mistake resulting in an illness should not strip a person of their entitlement to the benefits of belonging to society.

Resource allocation decisions are inevitable. But there are better criteria than Dr. Sheehan's.

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