Health

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.

Read More »Oxford Debates Cont’d – Opposer’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.

Read More »Oxford Debates Cont’d – Proposer’s Closing Statement

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.

Read More »Oxford Debates Cont’d – Opposer’s update 2

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

Opposer: Charles Foster
Update 1

It simply won't do to underplay the practical difficulties posed by this motion. The motion is not 'The NHS should not treat those illnesses which can be shown beyond any doubt to have been self-inflicted', but 'The NHS should not treat self-inflicted illness'.  The world of medical causation is simply not as straightforward as Mark Sheehan suggests. To reiterate: to prove a link in the general population between smoking and lung cancer is a very different thing from proving it in an individual patient.

There are no 'robust' or indeed any systems in the NHS for dealing with this sort of issue. Nor can there be. Questions of individual causation are argued expensively before the courts in clinical negligence cases. They are notoriously nightmarish. The same job can't be done by committees, however enlightened or well meaning.

Read More »Oxford Debates Cont’d – Opposer’s update 1

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

Opposer: Charles Foster (Barrister & teacher of medical law and ethics at
Oxford. He is attached to the Ethox Centre and is an Associate Fellow
of Green Templeton College)
Opening Statement

'The NHS has shown the world the way to healthcare, not as a privilege to be paid for, but as a fundamental human right', proclaimed the Department of Health in 2008. 'The values of the NHS – universal, tax-funded and free at the point of need – remain as fundamental today to the NHS as they were when it was launched in 1948.'

These values are important. We abandon or dilute them at our peril.

Mark Sheehan suggests that we have to grow up: to shoulder responsibility for our own actions and omissions. Why, he asks, should society pick up the bill for my stupidity?

There are many answers. Some of them will be ventilated over the next few weeks. But here are a few:

Read More »Oxford Debates Cont’d – Opposer’s Opening Statement

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

Proposer: Dr Mark Sheehan (Oxford BRC Ethics Fellow at the Ethox Centre and
James Martin Research Fellow in the Program on the Ethics of the New
Biosciences)
Opening Statement

We generally think that people are entitled to live their lives in the way that they see fit, in a way that best coheres with what they take to be meaningful and valuable. This is perhaps the central tenet of western liberal society. Liberal society is centred on permitting and perhaps even encouraging, different conceptions of 'the good' and experiments in living. Alongside this freedom, however, comes a responsibility for the decisions that one makes. Because society remains a collective effort the freedom to choose to live in a certain way brings with it responsibilities — here, responsibilities for the consequences of our choices.

Read More »Oxford Debates Cont’d – Proposer’s Opening Statement