Oxford Debates Cont’d – Proposer’s update 2

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

Proposer: Dr Mark Sheehan
Update 2

As Foster suggests we must be clear about the motion. So what might it mean to 'not treat self-inflicted illness'? If it means not treating an illness or condition that was in some way the result of choices of the patient, not only would the motion require that the NHS not treat the flu — if only people had no contact with each other — but it would be a complete waste of time to discuss.

The motion does raise an important issue, and a live issue, and so it should be given a sensible interpretation. Precisely because of this 'self-inflicted' must mean something like 'those illnesses that can be shown to be self-inflicted.' The background to all of this of course is the body of evidence surrounding particular kinds of life-style decisions. So when we refer to self-inflicted illness we do not mean all cases, but the subset of extreme examples where particular choices have been made and the knowledge that is clearly available in society has been ignored.

We also need to be clear about the ways in which the NHS might 'not treat.' First, 'not treating' can involve blocking access to particular care or procedures. Foster concedes that the processes in the NHS for making decisions about funding may conclude (apparently with some justification) that heavy smokers should not be given coronary bypasses — because they smoke. Clearly here, the choice to smoke by the patient means that they are denied treatment. The smoking causes the conditions that the make the coronary bypass likely to fail.

A second way in which the NHS might 'not treat' involves de-prioritising. Giving the ICU bed to the car accident victim rather than to the suicide attempt counts as not treating the suicide attempt, as does giving a lower ranking to alcoholics when allocating livers for transplant. The alcoholic may end up receiving a liver and the suicide may be found a bed in another hospital but the decision not to treat has been made in both cases by de-prioritising.

This debate is about a live issue and as such the terms of the motion need to be interpreted in a way that makes the debate sensible. None of these cases are simple and none of them are easy, but decisions of this sort of complexity, difficulty and consequence are made regularly in the NHS and, as I have suggested in my earlier posts, there is a good argument for these decisions being extended to include self-inflicted illness. 

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