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.

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"?

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.

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.

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.

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.