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UK: Don't treat the old and unhealthy, say doctors

The Telegraph, 1/26/08
Laura Donnelly, Health Correspondent

Doctors are calling for NHS treatment to be
withheld from patients who are too old or
who lead unhealthy lives.

Smokers, heavy drinkers, the obese and
the elderly should be barred from receiving
some operations, according to doctors, with
most saying the health service cannot afford
to provide free care to everyone.

Fertility treatment and "social" abortions
are also on the list of procedures that many
doctors say should not be funded by the state.

The findings of a survey conducted by Doctor
magazine sparked a fierce row last night, with
the British Medical Assn & campaign groups
describing the recommendations from family
& hospital doctors as "outrageous" & "disgraceful".

About one in 10 hospitals already deny some
surgery to obese patients and smokers, with
restrictions most common in hospitals battling
debt.

Managers defend the policies because of the
higher risk of complications on the operating
table for unfit patients. But critics believe that
patients are being denied care simply to save money.

The Government announced plans last week
to offer fat people cash incentives to diet and
exercise as part of a desperate strategy to steer
Britain off a course that will otherwise see half
the population dangerously overweight by 2050.

Obesity costs the British taxpayer L7 billion/year.
Overweight people are more likely to contract
diabetes, cancer & heart disease, & to require
replacement joints or stomach-stapling operations.

Meanwhile, L1.7 billion is spent treating diseases
caused by smoking, such as lung cancer, bronchitis
and emphysema, with a similar sum spent by the
NHS on alcohol problems. Cases of cirrhosis have
tripled over the past decade.

Among the survey of 870 family & hospital doctors,
almost 60 per cent said the NHS could not provide
full healthcare to everyone & that some individuals
should pay for services.

One in three said that elderly patients should not
be given free treatment if it were unlikely to do them
good for long. Half thought that smokers should be
denied a heart bypass, while a quarter believed that
the obese should be denied hip replacements.

Tony Calland, chairman of the BMA's ethics
committee, said it would be "outrageous" to limit care
on age grounds. Age Concern called the doctors'
views "disgraceful".

Gordon Brown promised this month that a new NHS
constitution would set out people's "responsibilities"
as well as their rights, a move interpreted as meaning
restrictions on patients who bring health problems on
themselves. The only sanction threatened so far,
however, is to send patients to the bottom of the
waiting list if they miss appointments.

The survey found that medical professionals wanted
to go much further in denying care to patients who
do not look after their bodies.

Ninety-four per cent said that an alcoholic who
refused to stop drinking should not be allowed a
liver transplant, while one in five said taxpayers
should not pay for "social abortions" and fertility
treatment.

Paul Mason, a GP in Portland, Dorset, said there
were good clinical reasons for denying surgery
to some patients. "The issue is: how much
responsibility do people take for their health?" he said.

"If an alcoholic is going to drink himself to death
then that is really sad, but if he gets the liver
transplant that is denied to someone else who
could have got the chance of life then that is a
tragedy." He said the case of George Best, who
drank himself to death in 2005, 3 years after a liver
transplant, had damaged the argument that
drinkers deserved a second chance.

However, Roger Williams, who carried out the
2002 transplant on the former footballer, said
doctors could never be sure if an alcoholic would
return to drinking, although most would expect a
detailed psychological assessment of patients,
who would be required to abstain for 6 months
before surgery.

Prof Williams said: "Less than 5 per cent of
alcoholics who have a transplant return to serious
drinking. George was one of them. It is actually
a pretty successful rate. I think the judgment these
doctors are making is nothing to do with the
clinical reasons for limiting such operations and
purely a moral decision."

Katherine Murphy, from the Patients' Assn, said
it would be wrong to deny treatment because of
a "lifestyle" factor. "The decision taken by the
doctor has to be the best clinical one, and it has
to be taken individually. It is morally wrong to
deny care on any other grounds," she said.

Responding to the survey's findings on the
treatment of the elderly, Dr Calland, of the BMA,
said: "If a patient of 90 needs a hip operation
they should get one. Yes, they might peg out any
time, but it's not our job to play God."
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