Should your lifestyle affect your eligibility for treatment on the NHS? Well nearly 40% of doctors think it should, saying smokers, drinkers and the obese should be barred from certain treatments.
The findings, from a new survey by the British Medical Association's magazine BMA News, follows an outcry over the decision by local NHS bodies to bar obese patients from undergoing joint surgery. Last November, three primary care trusts said overweight people in East Anglia will be denied replacement hips and knees, even if they are in serious pain, until they lose weight. They justified their decision with the claim that the surgery is less effective for overweight patients, with artificial joints wearing out sooner. But this was debunked by an expert.
So what really lies behind these moves to ban "unhealthy" people from NHS treatment? On the whole it's money - or the lack of it, with many NHS trusts facing a cash crisis. Last December the National Institute for Clinical Excellence, which decides whether treatments are cost-effective, advised it might be appropriate to deny treatment to patients whose ill-health was "self-inflicted". Analysts have warned that we all need to adopt healthier lifestyles in order to prevent the NHS budget from spiralling out of control.
With GP surgeries set to be opened in supermarkets perhaps doctors will in future monitor your till receipts to check you're not buying too many Hob Nobs and cheesy Wotsits.
But once you take the decision to deny some patients treatment because you decide it's their fault they're unwell, where does it end? Do you deny abortions to people because they should know how to use contraception, stop reviving people who attempt suicide, or refuse treatment for sexually transmitted infections because the patient sleeps around too much?
There's also the thorny issue of who is most likely to be affected by these bans. Obesity and poor diet are most common in deprived areas, where it is harder to get cheap fresh fruit and vegetables, so blanket treatment bans are likely to increase health inequalities. What is needed is more carrots, not just sticks.
