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The Forum > Article Comments > Personal responsibility and health discrimination > Comments

Personal responsibility and health discrimination : Comments

By Mirko Bagaric, published 17/9/2007

The medical needs of fatties and smokers should prevail over the whims of misguided morally deficient medicos.

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The author has hit the nail on the head with this:

"It is nothing but indecent to stand-by and allow others to endure preventable suffering."

Preventable. The key word here. Obesity and smoking are entirely preventable. Why should society be the net to catch those who have entirely preventable conditions?

"Their flawed conduct is self-regarding - it does not hurt others and in all probability they have a number of redeeming features"

It does hurt others. They are consuming resources which could be better spent on try medical needs.

"However, in an opulent society in Australia where we have virtually infinite medical resources it is rare that choices between patients need to be made."

We have a very finite amount of medical resources. They are already overstretched and further overloading it with "fatties and smokers" (the authors words) is not going to help.

No, this article was wrong in every sense: in the conceptual sense as well as the pragmatic sense
Posted by BN, Monday, 17 September 2007 9:11:36 AM
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If I follow your logic correctly, BN, we should expect - nay, demand - that triage in the emergency admissions area of a hospital should include an instant assessment of whether the car-crash patient was responsible for the accident that caused their condition.

Nothing less will do for you, I suspect. If indeed the crash was "avoidable", but the driver did not take the steps necessary to do so, they should be abandoned to their fate. In fact, why bother even to send an ambulance to the crash site, until BN has been summoned to assess who was in the right, who was in the wrong, and therefore who deserves treatment under the BN regime.

Also, if we follow the same BN path, why should we bother with rescue helicopters? Aren't they there simply to rescue people who chose to expose themselves to danger by walking in the Blue Mountains and carelessly falling into a ravine? Or folks who stupidly go for a swim when they are fully aware that doing so can land them in trouble?

Hey, why stop there? Take the name and address of everyone who buys a Big Mac, or a bucket of chips, and send the list to every hospital in the land, saying "do not admit this person in the event of a heart attack - it was all their own fault".

Is this the sort of country you would like to live in, BN?

No, I rather suspect not. But you would, on the other hand, like to be the person who decides who deserves treatment, and who fails to pass your morality test, wouldn't you?

That puts you in a fairly well-defined category of human being, BN. I'll leave you to work out which that is.
Posted by Pericles, Monday, 17 September 2007 9:57:20 AM
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That was a predictable response Pericles.

The clear difference between a car crash and obesity is that obesity is something that takes months and years of neglect to create - it is not a situation which happens in the blink of an eye, which a car crash often happens.

Is your policy to have an open cheque book in the medical system? If so, be prepared for significantly higher taxes to pay for that, particularly with the growth (pardon the pun) of rates of obesity. If not, where/when do people face the consequences of their actions (or inactions)? Obesity and smoking don't just happen - they are (almost universally) the result of decisions made by the person in terms of energy in (what's been eaten) and energy out (exercise).

Re burgers and chips, they are fine if you do the work to burn them off. I personally eat take away items all the time (not necesasrily burgers and chips), but then I'm in the gym 6 days a week to burn off all the calories that I take in.

This is a simple demonstration of taking responsibility - I know what I'm eating, so I do the work to avoid the consequences like obesity. Can you say the same thing?
Posted by BN, Monday, 17 September 2007 10:05:14 AM
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"Re burgers and chips, they are fine if you do the work to burn them off. I personally eat take away items all the time (not necesasrily burgers and chips), but then I'm in the gym 6 days a week to burn off all the calories that I take in."

How you do moralise, BN!

Mind you, people eating takeaways regularly are exposing themselves to health risks and you "personally eat take away items all the time."

For instance commercial manufacturing of chips includes a coating of fungus as a preservative - not fit for human consumption actually. Now that you are aware of that, perhaps you should refrain from risk taking behaviour.

Most take-aways are lathered in saturated fats. You may not be fat but your arteries could be!

Perhaps your risk taking behaviour will see you denied medical treatment should you succumb to the many insidious diseases caused by take-away (junk) foods.

Those other people who have obesity problems or smoke cigarettes are addicted. No-one really wants to over-indulge in food, alcohol, other drugs or cigarettes.

Do you recommend that bulimics and anorexics be denied medical treatment also? This too is an addiction, out of the victim's control.

Besides, how can we be sure that the surgeon treating his patient hasn't an addiction to morphine or some other substance?

The last time I took a friend to the emergency department of a hospitial, the female intern had a stud in her tongue and I'm convinced she also had breast implants?

Some health professionals advise that tongue studs could cause cancer and that leaky silicone breast implants can also cause serious complications.

Perhaps Clare, the lovely lass who died last week from melanoma caused by visits to solariums should have been denied medical treatment prior to her death. The risks from solarium tanning have been known for many years despite its ongoing popularity.

I have private medical insurance which I rarely use. I trust the surplus goes towards assisting others, regardless of their medical conditions.

As usual, Mirko has written a sensible and compassionate article! Dobra, dobra, Mirko!
Posted by dickie, Monday, 17 September 2007 10:56:43 AM
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Great BN which yank fast food giant do you want to ban first McDonald's or KFC. I can hear the howls from capitalism from here....free enterprise, we want to make a profit by exploiting children on the counter, leave us in peace. On the other hand, let society pay for the consequences by giving the problem at the end to public hospitals which are grossly underfunded by the Howard Government to deal with.

Education is the key and a turn away from US expansionism consumerism, but who is brave enough to stand up to the US and return our traditional culture to us. A. Nobody.
Posted by SHONGA, Monday, 17 September 2007 11:31:53 AM
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Goodness, so much emotion. It is a fact that obesity costs many billions of dollars in health care in Australia. It is also a fact that in a few years eighty percent of Australians will be overweight placing an insupportable burden on our already overstretched health care system. The consequences of this will be born by the few tax payers still slim enough to work.
Would you have any objection to health insurance premiums [including medicare] being tied to life-style choices? That way, fatties and smokers and thrill seekers would be funding their own eventual treatment.
Posted by ybgirp, Monday, 17 September 2007 11:39:30 AM
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>>That was a predictable response Pericles.<<

If it were that predictable, BN, you'd have prepared a more convincing rebuttal.

Your starting point was, let me remind you:

>>Why should society be the net to catch those who have entirely preventable conditions?<<

You now modify that with:

>>The clear difference between a car crash and obesity is that obesity is something that takes months and years of neglect to create - it is not a situation which happens in the blink of an eye, which a car crash often happens.<<

OK, so you have added a time factor to the preventability factor. Why should that be a determinant? Simply because it takes years to become obese or to succumb to the effects of smoking doesn't diminish the impact of "neglect" on the health system. Whether the neglect is over decades or in the space of a millisecond doesn't affect the outcome: individual "neglect" has a financial impact on all of us.

In a normal compassionate society, people are prepared to cope with the foibles of others without begrudging them a little flexibility. To insist, as you do BN, that only people whose lifestyles you personally approve of should be treated, you say more about yourself than about our Health system.
Posted by Pericles, Monday, 17 September 2007 11:54:57 AM
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Mirko demonstrates limited understanding of health economics as well as the role of the doctor in providing advice on surgery.

Doctors do not refuse patients treatment because on their own judgements of their relative merit to society (based on their lifestyle or any other factor).

Decisions regarding offering surgical procedures are made by doctors based on a calculation of benefits versus harm to the individual patient. It is well documented that morbidly obese individuals are high risk patients to operate on. They are more risky to anaesthetise, perform operations on, have longer operation times and higher complication rates. The risks of their operation outweigh the potential benefits. That is not to say that should their situation improve as a result of lifestyle or medical intervention they would not be reconsidered for the procedure.

Secondly, although it is not our role to assess a patients net worth to society prior to offering or declining them treatment at some point we need to rationalise service provision. There is obviously not a infinite amount of health care resources and some justification must be used when allocating resources. A commonly cited instance of medical arrogance is the refusal of coronary artery bypass surgery to patients with heart disease who are still smoking. When you consider that smoking is the single biggest accelerator of coronary artery atherosclerosis, if a given surgeon can only operate on 200 patients a year (limited by theatre time, nursing staffing, medical staffing, hospital beds) should they operate on the non/ex smokers, for which he is likely to provide sustained benefit and many years of extra life? Or operate on smokers as well, whom will have higher rates of post op wound infection and reclag their arteries within a few years?

Every treatment whether medication, operation, vaccine or health promotion has to justify provision. Any drug subsidised by the PBS must demonstrate significant benefit (cost per person year saved) acceptable to the public purse. Operations are no different and for reasons detailed above, the sums stack up differently for smokers than for non smokers.
Posted by c-bearup, Monday, 17 September 2007 12:16:45 PM
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As far as I am concerned smokers are the scum of the earth, and any political party that would be brave enough to prevent smoker's from taking up valuable resources in hospitals would get my vote even if they were the KKK.

For it seems that non smoker's like myself (never smoked in my life) can't even walk down the street without some smoker/s stinking up my space, and droping their butts on the ground. Office smoker's should be singled out for special treatment as they seem to spend most of their work time outside of their building's with their friends smoking instead of working.

As for obese people, send them all to Uluru in a truck and let them walk home, they will either survive and get thin or die of starvation.
Posted by Yindin, Monday, 17 September 2007 12:29:36 PM
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'The Federal government must immediately pass laws prohibiting health discrimination on the basis of consumption choices.

This raises more issues rather than offer answers. Should drug addicts continue to get needles free when some diabetics struggle to pay for them. Should naval officers get free breast implants and others not. I am sure you will find justification for anything on psychological grounds. It seems impossible to come up with discrimination laws that don't discriminate! Don't airlines discriminate forcing some very obese people to buy 2 tickets?
Posted by runner, Monday, 17 September 2007 12:52:48 PM
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Too true, Shonga.

c-bearup

Some good points, however, does the priority list mean that smokers and the obese are second class citizens who are denied treatment due to government stuff-ups?

What is disgraceful is the fact that Mr Howard has forced Medicare payers who are employed, to also subscribe to a private health fund and those who fail to, are penalised with an additional Medicare surcharge.

One could naively believe that Howard's way was to relieve pressure on the public health system.

No so - the public health system in every state is under seige and citizens are dying as a result.

It clearly reveals that Australian governments are responsible for direct mismanagement and lack of foresight. It is now time for THEM to take personal responsiblity.

The Director of Health in Western Australia receives a salary in excess of $500,000/pa and the public health system in that state is an abysmal failure.

With my private insurance, specialists are available at the ready. Without the insurance, I may have to wait years for medical treatment even if the condition is not "self-inficted."

One should not hold citizens (in need of any type of treatment) responsible for this ignominious state of affairs.
Posted by dickie, Monday, 17 September 2007 1:36:57 PM
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If we accept the article's naive view that we have "virtually infinite medical resources", it would be wrong to turn away people from medical care regardless of what life choices they have made. However since this isn't the case in reality, we need to make some hard choices about who pays for the medical care, how much should a person be responsible for their own choices, and how effective a treatment will be. I think the biggest issue is that people who make choices that increase their need for health care, should not expect everyone else to pay for the increase in costs.

"It is nothing but indecent to stand-by and allow others to endure preventable suffering."

What if the doctor's judgment is the short term suffering may result in a behaviour change to the betterment of long term health? Should the doctor assist in the degradation of health problems through poor lifestyle choices? Compare it to a case where an athlete is injured; should the doctor administer paid medication so the athlete can still compete even though it will result in further injury?

"Their flawed conduct is self-regarding - it does not hurt others... "

In the case of smoking, second hand smoke can cause harm; either way there is the financial harm done to society from increased medical costs.

"..and in all probability they have a number of redeeming features."

Everyone is a mixture of positive and negative features. To excuse the bad with the good is to ignore the potential for improvement. Shouldn't we encourage people to lead better lives?

"They should not be subjected to the puritanical indecent whims of a morally deficient medico."

While I am sure that there are many cases of bad judgment, after all medical professionals are human, I think this is quite an unwarranted attack on the medical community. Medical professionals spend their lives trying to improve the health of other people. I think it's understandable if they get a little frustrated when people throw their health away smoking a toxic substance or stuffing their face full of sugar and lard.
Posted by Desipis, Monday, 17 September 2007 2:03:05 PM
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The problem of lifestyle contribution to personal ill health is widely spread across the individual health spectrum. Certainly smoking and obesity are the big guns, but there are many more. For example does a refusal to comply with safety instructions qualify as 'self induced' illness in the event of an accident? What about attempted suicide, anorexia, alcohol indulgence, hit by a truck whilst jogging, extreme religious beliefs, etc etc? The remark attributed to Seneca that 'the way to extend life is to avoid shortening it' is as valid and far reaching today as it was some two thousand years ago. Almost every action contributes in some way to our eventual physical collapse, and to isolate and punish only some of those actions, albeit the most significant, leaves ethical problems that seem to be without virtual solution. It is manifestly unfair to throw it all on to the medical profession.
Posted by GYM-FISH, Monday, 17 September 2007 2:12:58 PM
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Re Mirko's faith that:

" ...in an opulent society in Australia where we have virtually infinite medical resources it is rare that choices between patients need to be made."

What - ?

Triage is all about making choices between patients in the face of limited (virtually non-infinite)resources.

Plainly, in the case of emergency room overload and limited medical staff, triage is the routine strategy. But what about leaving patients in ambulances on a normal day? Like, maybe one day last week, in Melbourne?

The gentle reader may wish to consider:
"Gridlock in hospital system: ambos"
By Lexi Metherell

Posted 2 hours 56 minutes ago
Updated 1 hour 29 minutes ago
http://abc.net.au/news/stories/2007/09/17/2034559.htm?section=justin


"Ambulance workers say delays are increasing (ABC)

The Ambulance Employees Association has called for a summit to address what it has described as "gridlock" in the hospital system."

"The Association's Secretary Steve McGhie says there is evidence ambulances are waiting up to an hour and a half to drop patients off."

"He says the problem is partly due to a bed shortage, caused by the number of elderly patients in hospitals."

"
"There needs to be a summit or a forum with the government, and the hospitals... and the Government, and the ambulance service to try and come up with some resolutions to this," he said."

And Mirko, what about closing hospitals and health services in rural and remote Australia? Are we doing this because we have "virtually infinite medical resources"?

Is this opinion piece about the inalienable rights of smokers and the obese (and equally the rest of us, most of the time), or is it another wind-up, like your amazing and incredible torture-justification piece?

(readers can check the links below for the archived item):
www.theage.com.au/news/Opinion/A-case-for-torture/2005/05/16/1116095904947.html
or
http://www.able2know.com/forums/about51696.html

Or - is there "something going on, and you don't know what it is"?
Posted by Sir Vivor, Monday, 17 September 2007 2:21:09 PM
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Mirko's statement " ...in an opulent society in Australia where we have virtually infinite medical resources it is rare that choices between patients need to be made." is too glib by half and typical pollyanna mythologising.

The only thing "infinite" is the ideas space in Mirko's head. He needs to get out into the real world where ordinary people live and for whom the health system was designed to serve. He needs to get in a queue in a hospital and see how infinite the medical resources are.

Precisely because resources ARE finite, I reckon there's some merit in making it harder (or dearer) for fatties and smokers to access medical services. Then, at least, they're getting a "market signal" that their behaviour is far from ideal and that maybe they should think about changing it.
Posted by RobP, Monday, 17 September 2007 2:56:04 PM
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I agree with Mirko on this issue.

c-bearup
You’re right, overweight patients or drug addicts may be refused treatment because their condition lessens the potential benefits and heightens the risk. But this is a red herring, as it is not the case Mirko is writing about. He’s concerned with the case of refusing treatment BECAUSE the patient is deemed to have contributed to their condition, which is clearly the position advocated by BN and Yindin.

An easy way to distinguish the two is to consider what would happen if the diminished benefit or heightened risk was due to some cause beyond the patient’s control, for example another illness. If you’d refuse to treat a patient with similar complicating factors for which they are not “responsible”, then – and only then – it may be acceptable to refuse to treat a patient who is deemed “responsible”.

Desipis,
You ask“What if the doctor's judgment is the short term suffering may result in a behaviour change to the betterment of long term health?” Are you seriously suggesting that doctors should let people suffer to discourage them from smoking/over-eating/drinking/watching TV? Why stop at refusing treatment? Let’s jail boozers, flog fatties and put smokers in the stocks. For their own good, of course.
Posted by Rhian, Monday, 17 September 2007 3:16:28 PM
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Rhian,
It is actually Mirko who is casting about the 'red herrings'. Either he knows nothing about the issue he is writing about or he is being totally disingenuous. I don't believe there has ever been any discussion or medical policy to deny the obese and smokers elective surgery because they have contributed to their conditions. The only procedures mooted for restriction are those that carry with them an inordinate risk of morbidity, mortality or relapse. (For instance, liposuction and body recontouring in the morbidly obese; certain lung/ cardiac surgery in patients who can't/ won't give up smoking.)

Decisions re surgery are made all the time based on factors for which patients have no 'responsibility' (age, frailty, non-related medical conditions to name a few). Perhaps you don't think this is fair either, but then again I bet that you (and certainly not the moralising Mirko) have ever had to deal with the sequelae of surgical complications in these compromised patient groups.
Posted by Kassie, Monday, 17 September 2007 5:11:44 PM
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I completely agree with Kassie.

If the treatment runs a real risk of being worse than the disease, you don't offer the treatment. What might appear institutional discrimination to one uninformed is actually doing the best thing for the patient.

Unless Mirko is prepared to provide some specific evidence backing his claims he should let medical staff conduct their own risk assessments on operations they perform.
Posted by c-bearup, Monday, 17 September 2007 5:43:52 PM
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Australian tax on cigarettes aud$269.05 per kilo.

Sounds like a lot of money those smokers are contributing to the Australian treasury.
Posted by Kipp, Monday, 17 September 2007 5:53:42 PM
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Australian tax on cigarettes aud$269.05 per kilo.

Sounds like a lot of money those smokers are contributing to the Australian treasury.
Posted by Kipp,
The consequent medical bills are greater than their contributions - which end up in general revenue anyway - not in the health budget.
Posted by ybgirp, Monday, 17 September 2007 6:20:12 PM
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To the sale of cigarettes, Aussie smokers contribute aud$3,000,000,000. To the Australian treasury.

Working in a hospital, I always have my break with fellow medico colleagues. Nurses and doctors in the smokoe area. Its more social!

BTW I dont smoke, and I aint unhappy! But the more social patients and staff, are those that smoke.

Its so easy to put down people, why is it so hard to respect people?
Posted by Kipp, Monday, 17 September 2007 7:35:57 PM
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Could the reason that drug addicts, & aids suffers, are not being considered here, as people who should not be treated, have anything to do with choise of self indulgence of the majority of the contributors here?

It would appear to me that both of these pastimes contribute much less to government coffers, & are a much greater drain, than the indulgences being denigrated.

Should I now duck?
Posted by Hasbeen, Monday, 17 September 2007 7:52:21 PM
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Kassie
I’m well aware that many factors affect decisions to provide or withhold certain treatments, of which obesity and smoking are only two. If the only consideration is the welfare of the patient, there’s not a problem.

In the UK there has been extended debate about policies of some health providers that refuse some types of treatment to smokers or the obese. These are not based solely on clinical considerations of the best interest of the patient, they are ways of saving money.

It’s one thing to say an obese person is less likely to survive surgery and so it’s not worth the risk of replacing their hip; quite another to say their hip replacement will wear out faster, so hip replacements should go by priority to the thin - even though, on a strict accounting calculus, the benefit to the thin person will be more valuable.

Look at what other posters are saying. A large proportion think Mirko is wrong, not because he incorrectly assumes that decisions are made on the basis of perceived responsibility, but because they believe that’s how decisions SHOULD be made.

As an ethicist, Mirko has every right to address this issue if it’s a commonly held view that smokers etc do not deserve medical treatment.
Posted by Rhian, Monday, 17 September 2007 8:02:28 PM
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Rhian,
I have no interest in whether most of the respondents happen to think Mirko is wrong because they feel that valuable health resources should be withheld from 'irresponsible' patients - that is their opinion, not mine and not the policy or consensus of health providers in Australia.

As I said, I think the writer is being totally disingenuous. He has constructed this 'morally deficiant medico' from which to hang his polemic. He strikes me more as a provocateur than an ethicist - not that there's anything wrong with being provocative. I just think he needs to get his facts straight or perhaps provide some evidence for his assertions.

And I did have a chuckle at his final paragraph; in an era where the sticky fingers of the law are intruding into every area of life, to accuse doctors of a lack of deference and an over-willingness 'to arrogate to themselves treatment decisions' shows Mirko Bargaric has either a very good sense of humour or absolutely no insight.
Posted by Kassie, Monday, 17 September 2007 9:20:58 PM
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I agree somewhat with the original article, on the basis that the fit in this society seem often to have a sense of smug self-rightousness about them.

In practice, it may be that the obese researcher, the stressed smoker or the shift-working burger muncher are doing more for the country - in fact, it'd be quite possible that these people are looking after relatives or tending to patients when others are cheerfully toddling along to their gyms.

A law would be a blunt instrument, but I do suggest that people work harder at looking below the surface when judging the worth of others.
Posted by WhiteWombat, Monday, 17 September 2007 9:49:28 PM
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If medical authorities are heartless enough to carry out the murder of the unborn simply for convenience then any other comparisons seem to fade.
Posted by runner, Monday, 17 September 2007 10:07:54 PM
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Mirko might consider how hospitals are funded. More specifically, he might ask whether treatments are funded on an average basis or according to the risk profile of the patient. Fund patients according to their risk profile and there could be no question that the decision making is purely in the patients' interest. As an example, he might examine why Jayant Patel was so popular with the Bundaberg Hospital's management. Was it his kill record or the way he looked on paper?

Then there is the question of what might successfully reduce the risk profile of the population? No, it's much easier to shoot the messenger.

Mirko's approach is a bit like giving a lumberjack a hatchet and then complaining that all he ever cuts down is saplings.

Nice hatchet job, Mirko.
Posted by Fester, Monday, 17 September 2007 10:19:17 PM
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""BN - "I'M in the Gym 6days a week to burn off the calories I take in".

So you have become a fundamentalist exercise fanatic and you now want to send in the exercise police (religious police) to make sure those heretics who do not go to the gym 6days a week are refused medical treatment.

Human nature never changes.

What if you find you have damaged your joints or something in ten years time. Should you then be refused treatment because you placed all that extra strain on them.
Fat people are not always less healthy than skinny people. There are a lot of skinny people with serious health problems too.
Incidently I myself exercise for an hour three to four times a week but I dont judge myself as any less likely to have serious health problems than people who dont. It is often just the luck of the draw and genetics for some people.
People in non Western countries are regularly denied medical treatment simply because they were not born in Western countries.
Maybe as a westener it would be good if you gave up your doctors visits to someone in the third world so things would be fairer.

Having made those points I do think it is madness to smoke and I can understand the Doctors frustration at the medical problems caused by this but those same smokers would have eventually died of cancer or heart disease anyway (You have to die from something) so the cost is just being incurred soooner.
Posted by sharkfin, Monday, 17 September 2007 10:30:54 PM
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If you have medical problems because you have PERSONALLY made yourself fat or you choose to smoke etc etc ad infinitum, then you have to PERSONALLY carry the consequences. You did it - you take the hit. Don't blame the doctors, blame yourself, you self indulgent prick.
Too fat? Put down the fork, get off your bum and walk occasionally. Smoker? Quit! Heavy drinker? Die, you deserve it!
Hasbeen: I believe you should duck on the AIDS issue 'cause it can come to a person more-or-less via a third or fourth party or blood transfusions. Besides that, good on ya.
Yindin: A cigarette would do you good.
Posted by enkew, Tuesday, 18 September 2007 7:14:37 AM
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As a society we dole out charity to the deserving poor.

Obesity and smoking are more prevalent in the lower socio-economic groups.

I agree with Kassie and c-bearup that smoking and obesity increase the risks of surgery and the poster that said that the risks of obesity and smoking were being used to ration services offered to these patients to save money.

My partner had terminal melanoma, no solarium exposure and no private health insurance. The oncologist suggested we take out private health insurance so I went to Medicare to make enquiries about how long he would have to stay alive to take advantage of his private health insurance with a pre-existing ailment. Told doctor that we could pay the bills ourselves but the doctors couldn't cost the treatments. Very unpleasant wondering whether you are getting second class treatment because the medico is pushing a political barrow.
Posted by billie, Tuesday, 18 September 2007 8:38:44 AM
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WhiteWombat: "...the fit in this society seem often to have a sense of smug self-righteousness about them."

One of the key factors in gaining respect from others is to have respect for oneself. The obese and smokers clearly have no respect for their health or life, so it's not surprising that others don't either.

"In practice, it may be that the obese researcher, the stressed smoker or the shift-working burger muncher are doing more for the country..."

No. In practice, people with poor health are much less productive than those in good health. While a specific unhealthy person may be more productive than a particular healthy person, that particular person would be more productive if they improved their health.

"...in fact, it'd be quite possible that these people are looking after relatives or tending to patients when others are cheerfully toddling along to their gyms."

These people would be capable of providing better care for others if they took better care of themselves, as well as being less likely to become patients themselves in the future.

"...I do suggest that people work harder at looking below the surface when judging the worth of others."

Obesity & smoking are an outward sign of an inward problem. While it does not imply a lack of worth, it does tend to indicate a lack of self respect, self discipline and poor judgment, which are all important character traits.
Posted by Desipis, Tuesday, 18 September 2007 10:38:22 AM
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I left a couple of questions in my last response for those who side with the original author which no one has touched on. Those were:

Is your policy to have an open cheque book in the medical system? If so, be prepared for significantly higher taxes to pay for that, particularly with the growth (pardon the pun) of rates of obesity.

If not, where/when do people face the consequences of their actions (or inactions)?

It's telling that no one bothered to respond. Apparently we all expect to have unlimited (and unrestricted) medical care, while no one is willing to pay for it, and the idea of rationing is so unpalatable. I think a dose of reality is required here.

Sharkfin: "...in the exercise police (religious police) to make sure those heretics who do not go to the gym 6days a week are refused medical treatment"

No. What I said is that I take responsibility for my actions (my eating habits). I'm not suggesting that others eat the way I do, nor train the way that I do. However it's (reasonable) to expectothers will take responsibility for themselves, which means not being overweight etc.

Re your last paragraph Pericles, it's just silly to suggest that I approve of peoples lifestlye. As I said above, it's reasonable to expect others to look after themselves.
Posted by BN, Tuesday, 18 September 2007 12:42:31 PM
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I agree, BN, however, you misunderstand OLO... it isn't a discussion forum it's a place to air one's opinions.
In an earlier post I asked if people thought health insurance premiums - including medicare, should be linked to risk factors such as smoking and obesity, but of course no one responded to that, and I didnt expect them to, that would require thinking about someone else's opinion.
Posted by ybgirp, Tuesday, 18 September 2007 12:52:47 PM
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ybigirp (sorry if my casual memory cannot hold 7 letters accurately in short term memory).
You raise very interesting issues in your question about insurance and predictability of risk.
As more and more deteriminants of liability are understood, insurance becomes less and less attractive. If odds could be calculated precisely, why would anyone want to pay the premiums that merely balanced the likelihood of return, and in addition pay the costs of the administration of the no-lose no-win system. Insurance is only attractive as a means of sharing unpredictable losses. As more and more parameters of risk are understood insurance will become less and less attractive. Those of high risk will pay huge premiums and those of lower risk will pay merely the costs of lavish and inefficient administration, better to self insure.
Posted by Fencepost, Wednesday, 19 September 2007 7:14:02 PM
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BN- "is it your policy to have an open cheque book in the medical system".

That is a question that will have to be addressed with our aging population. Do you use expensive machines and medication to keep a sixty-five year old alive as opposed to a young child or person in their twenties if there is not enough money to go around. What if you need some expensive medical treatment when you are sixty five are you prepared to forgo it on financial grounds? I have a close family member who is actually high up in the financial administration of a hospital department and we have had this discussion on occasion.

Exercise and healthy eating is good as far as it goes but it does not make you as bullet proof as some people in our society would have us believe. After a few more decades of living some of these fitness fanatics will come to realise this. It may help you not to shorten your life but it wont help you to lengthen your life as that is genetically determined to a fairly large extent. The bible noted that the life expectancy back then was 3score years and ten and if you read the funeral notices in the paper every day you will see that that is still the average with a percentage of people living 10-15years longer than 70 and a lot of people dying in their 50's 60's and 70's also.

It is also known that young girls gain weight as a defence against sexual abuse and that is apparently wide spread in our communities.
So you cannot judge people who are overweight because you do not know their life stories.
Posted by sharkfin, Wednesday, 19 September 2007 9:24:06 PM
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