Oxford Debates Cont’d – Proposer’s Closing Statement

Part of the debate "The NHS should not treat self-inflicted illness"
Proposer: Dr Mark Sheehan

Closing Statement

What is most difficult about topics such as this one is that there are clear intuitions on both sides. These intuitions pull against each other and tempt us to focus on extremes at either end. The solution lies in the middle, where we can respect the desire to care for all those who are suffering as well as taking seriously the network of rights and responsibilities on which society is based.

I have developed two main lines of reasoning in the course of this debate. The first is a general one about the way in which we understand the relationship between individual members of society and society itself: alongside the rights and benefits accruing to individuals that come with being a part of society, there are also responsibilities. The key issue in this debate is how we, as a society, hold people responsible for the decisions that they make. Foster has clearly demonstrated a willingness to hold people responsible by denying them treatment — denying a coronary bypass to those who continue to smoke. I suspect that most people agree for some relevantly similar case.

The second line of reasoning involves the issue of rationing and uncomfortably pits individual against individual. If one person is treated another is not — there is very little money spent on palliative care so people die with pain that could have been relieved. Instead, the money may go to infertility treatment or to better surgical equipment — helping those without children to have them or making surgery more effective and efficient. When we are wrestling with these day-to-day problems the argument above is relevant. When a decision must be made between individuals or between groups of individuals, the responsibilities, as well as the rights of individuals, appropriately play a role.

These arguments do not mean that just anything goes. It is only if we focus on an extreme interpretation of 'self-inflicted' that we generate absurd consequences of denying treatment because of one cigarette. 'Self-inflicted,' as it is used here, picks out a set of lifestyle choices that individuals make in the face of clear evidence of harm. In enough cases the empirical evidence and the causation is clear for responsibility to be a part of the decision-making process.

Once we recognise the range of ways of holding people responsible and the range of ways of failing to treat, it is clear that lifestyle choices are a relevant factor in allocating NHS resources.

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