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Oxford Debates Cont’d – Opposer’s update 2

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

Opposer: Charles Foster
Update 2

Dr. Sheehan has fairly and inevitably surrendered. The motion as it stands is wholly unarguable.

But he contends that there are still important matters to discuss. I agree. Let's look at the 'subset of extreme examples' he relies on, where it is blindingly obvious that injury has been self-inflicted. The three clearest examples are perhaps attempted suicides, injuries resulting from dangerous sports, and some road traffic accidents.

We need to start by chasing away one red herring: insurance.  Of course bungee jumpers and parachutists should be insured. Insurance is mandatory for drivers. I have no difficulty with the proposition that the NHS should recoup the cost of care from the bungee jumper's insurer. But let's suppose that the insurance company won't pay. There could be many reasons. The jumper's wife might have failed to post a letter; the tour operator, unbeknown to the jumper, might not have been on the insurer's approved list; the insurer might litigate long and hard to avoid liability on a technicality.

But let's assume that the failure to get insurance is the jumper's or the driver's fault. Dr. Sheehan's position is then plain. If the patient turns up on his stretcher at the hospital door, he is turned away. If he can't find the funds for the treatment, he gets nothing from anyone.

Dr. Sheehan's logic must compel him to assert too that the patient should get no state assistance in respect of any of the consequences of his injuries. He should get no wheelchair, no disability benefits and no free bus pass.  He made a bad decision once, and so he is thrown into the societal outer darkness for ever. He's a greater pariah than any convicted criminal.

That response is grotesquely disproportionate to the patient's default. It is effectively punitive.

It is interesting and significant that Dr. Sheehan has shied away in argument from detailed citation of real facts and realistic scenarios. He is wise to do so. His strength, such as it is, lies in abstraction. He is particularly concerned to safeguard the resources available to treat other NHS patients – the ones he arbitrarily deems blameless. And he is careful to keep those blameless ones as abstractions. If they show their faces we can see that they are not all that different from the bungee jumper.

There are resources enough for the really needy. Intelligent stewardship of the available resources doesn't demand deployment of the arbitrary exclusion criteria beloved of Dr. Sheehan.

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