SELF-INFLICTED RATIONING

Abstract

Who said the health service could not resolve its funding crisis? Britain's cardiac surgeons have come up with a solution that will solve the government's problems at a stroke: the withdrawal of treatment for self-inflicted sickness. Surgeons at two separate medical centers were reported last week to have withdrawn non-urgent coronary bypass operations from patients who were refusing to give up smoking. The potential for savings seems unlimited if the same principle is applied to other medical cases: drinkers in need of liver transplantation, HIV patients who acquired the infection through drug addiction or promiscuous sex, heart patients who are overweight, accident victims who had been driving carelessly or under the influence of drink, and those with sports injuries, not to mention smokers with lung cancer... The debate raises complex philosophical issues that need to be pursued—eg, the right to use statistics that apply to a category of people to deny treatment to an individual. Yet in an age rightly requiring individuals to take more responsibility for the consequences of their behavior, self-inflicted injuries cannot be totally ignored. Doctors themselves may well revolt when they see politicians shifting responsibility for what are basic rationing decisions on to doctors' shoulders. The issues raised are not primarily medical, but political: what criteria should be used for rationing resources?