To think that if you need very expensive medical treatment due to a self inflicticted cause, the NHS should still pay?

[BoobleBeep]

I have been wondering about this.

If someone smokes 40 a day, drinks extremely heavily or is morbidley obese and has been given all the treatment available on the NHS to try and help them with their condition but still continues to smoke/drink/eat and as a rsult needs expensive surgery should the NHS pay?

The classic example is the smoker that has severe respiratory problems requiring them to have an oxygen cylinder and mask in order to breathe at home. If they do not agree to stop smoking, they cannot have this treatment at home... they have to go into hospital. Reason is not some judgemental view on the rights and wrongs of smoking. It's that if they light up around oxygen cylinders they stand to blow themselves sky high.

It's not always black & white. Leave clinical decisions to clinicians.

I feel sorry for the patient (whoever it was) needing a liver transplant, who died because George Best got it.

Maybe George Best was the only possible tissue match for that liver. Only the clinicians know the answer to that one.

YANBU. Where would you draw the line? None of us live the "perfect" healthy life.

And who decides whose illness is self-inflicted and who deserves treatment?

Do we ignore the significant genetic component to diseases?

Do I refuse to treat my Type 2 diabetes patients because most of them could have avoided it?

How do we decide how much someone contributed to their disease, given there are almost ALWAYS lifestyle factors?

Do we refuse treatment of women with breast cancer because a lot of cases could be prevented by better diet, less alcohol and more breastfeeding?

I am glad not to have to deal with such nonsense ideas and will continue to treat patients who need my help, regardless of how they ended up needing my help.

Allabout sorry for your situation. It is of course ridiculously frustrating when someone refuses treatment for the root cause of their conditions (ie the addiction) but honestly? We have an NHS which is free at the point of need and it's down to clinicians and resource managers to make these decisions for us, precisely so we aren't going 'Well hang on a minute, I need this more than MotherAllAbout because she has brought it on herself.'

The only exception to this rule (IMO) are the numpties that call ambulances for minor injuries and the like.

Yes, the NHS should still pay - for all the reasons mentioned above.

It always seems to be the case in these arguments that the examples given as reasons why people should have to pay for their own treatment seem designed to appeal to people's sense of disgust at certain types of people. Typically, there will be an outcry over the morbidly obese person who gets NHS treatment because 'they could just stop eating so much' - while the same people would be horrified at someone being refused treatment for anorexia because 'they could just eat more'. Similarly, it's easy to be disgusted at the standard image of the messy, unpleasant alcoholic who gets a new liver and then carries on drinking - not so easy if you mention the 20-something snowboarding fanatic who gets his broken leg fixed and then heads back to the slopes.

Maybe the NHS should start charging those stupid ill-equipped wannabe hill-walker people who traipse around our Scottish mountains, get into trouble, fall down gullys and injure themselves with the addition of some nice hypothermia. Then have to be helicoptered out.
Or the horse riders and rugby players.
Or the women who don't go for smear tests until they have advanced cervical cancer.
Or the sun-worshippers with skin cancer.
Where would it all end.

I know what you are all saying, the majority are saying yes
BUT
dear lord it just wears SO thin some days...not every day but it does some days.
Where i work, its in excess of £1K per day per bed. We never have enough beds, we are always full, on a daily basis we have to juggle and switch and think creatively in order to provide a service.
When 50% of our beds are occupied by alcoholics or drug addicts or morbidly obese people (who are a whole other ball game) and there are sick people and children that may need one of those beds, it gets utterly utterly frustrating.
Then when they wake up and spit at and assault staff, and their families steal money from the coffee machne and turn up drunk shouting the odds.

Its a struggle to keep it in your head that they are as deserving as the baby who has stopped breathing in an A&E cubicle having to wait for a transport team from another hospital, when she should be safe and cared for in one of our beds.
Or the man with the perforated bowel due to cancer he didnt know he had having to wait in a theatre recovery area for 5-6 hours when he should be settled and safe in one of our beds, while we have to get hospital security down to stop the alcoholic in bed 4 from punching the nurse in the face again as she tries to clean up the shit that he is laid in. who cannot be discharged from our ward as the gastro ward is also full to the brim with alcoholics.
wears thin. Hard to keep that thought some days.
sorry.

If you are a health professional then it sounds as though you need to use your supervision process, i don't beleive that these thoughts aren't affecting your practice.

You should be dealing with this 'burn out' (varcarious trauma) in your work place not on a internet forum.

yup, burn out, defo. Mind you ve been doing it for 22 years and so knew it would come at some point ive not done bad to get to 22 years.

We were talking about it the other day at work, its very intersting how folk see it in different ways. But then we went back in and a little lady i was looking after gave me a huge thumbs up and smile as i took her a slice of toast, THATS so worth it all, made my day.

Can't believe a thread like this on MN and nobody's mentioned having a baby as a self (almost!) inflicted medical condition - should we pay for pregnancy costs of care?

cogito that used to be my grandad - sit there with a cigarette in one hand and oxygen in the other. despite this he lasted until his late 80's; much to everybody's surprise as we thought that he would blow himself up before he keeled over from natural causes. In the end he was given a couple of months to live with aggressive throat cancer and lasted a couple of years.

Needless to say whenever my gran (or anybodyelse!) found him smoking with his oxygen she always hit the roof but he always drubbed the ciggie out and then lit up a few minutes later when she wasn't around...

Oops. Meant to have several in that first para of my post! That will teach me to post without double checking after several interruptions from the dc

It's always a tough one when talking about people who lived through WW2 as my GM died of lung cancer which they put down to her being trapped under a bombed building for two days, despite her being a smoker (she started when they were handed out by government officials in an air raid shelter, my DM started smoking at the same time).

I have seen many elderly men who served in the army oversees, who have had skin cancer patches cut out because they had no choice but to get sun burned.

I agree with zipzap, technically pregnancy is a self inflicted lifestyle choice, why should antenatal care be free but not addiction treatment, gastric bypass etc. The healthcare system should either be free for everyone as we have now or everyone pays like they have in the USA, you can't differentiate between who "deserves" treatment or not, its more complicated than that.

If someone smokes 40 a day, drinks extremely heavily or is morbidley obese and has been given all the treatment available on the NHS to try and help them with their condition but still continues to smoke/drink/eat and as a rsult needs expensive surgery should the NHS pay?

No! Because the NHS does not fund endless treatment for people with illnesses that are not self inflicted.

For example, someone with cancer. With an agressive form, there comes a point where treatment wont help and apllative care is the only option. The NHS would not continue to fund bone marrow transplants, radical surgeries, aggressive chemo, etc if they knew it wouldn't work. A dear colleague of mine went through this recently, may she rest in peace. The NHS would not give her radical treatment as they knew it wouldnt help.

As a general rule, the NHS does not fund endless treatment that does not work. Why should they? By the same reasoning the person who smokes 40 a day and is morbidly obese sheould be treated the same. If all of the diet, exercise, self help courses, stop smoking courses, patches, chewing gum, and all of the help available on the NHS does not work and the person wont change there ways, it should be withdrawn.

BUT only after everything has been tried. You give them all the help and support available for a long time, a least a couple of years, but if no improvement, leave them to it, let them smoke, drink, eat themselves to death. It's no different to how anyone else with a non self inflicted illness would be treated if treatment wasn't working.

The problem though is lots of things are self inflicted in a way. For example, horse riding leads to a relatively high proportion of serious injuries - being paralysed. Travelling abroad - even with recommended injections - lays us open to infectious diseases that are unusual/unknown here. Not taking enough exercise is an important risk factor for cardo vascular disease. Not using sunscreen - usually when we are teenagers/early twenties increases the risk of sun cancer. As does teenagers using sun beds.

About 40% of serious illnesses are due to genetics or environmental factors over which we have little control. The rest are in some way self inflicted. Are we really going to consign 60% of people to no medical care.

I do agree strongly that alcoholics should not be entitled to DLA for alcoholism. It is fine if it is for disabilities that happen as a direct result of alcoholism. This isn't actually a value judgement. But practically giving them extra money only makes things worse - they can buy even more drink - and thus is a total waste of taxpayers money.

I still remember being shocked when I found out that alcoholics I came across through work were getting DLA for their alcoholism. I have heard drug addicts can get the same. And it is because DLA is based purely on what you can and cannot do with no consideration of the cause. So if you can prove that you need supervision for example, because you are falling over drunk a lot and so at risk of falling into traffic, etc, then the fact that this is because of alcoholism makes no difference to entitlement.

Yes they should pay because 'self infliction' is so difficult to prove. Imagine how many would suddenly need 'therapy' on the NHS to try to find a reason for their self infliction in order not to have to pay?

And why 'morbidly obese'? There are far more people who are ruining their health by eating crap and not exercising than just morbidly obese people.

It's a minefield and the court costs alone would probably run into more than the treatment.

That Tony Bullimore clown is not dissimilar to the snowboarder mentioned above. Bullimore took off on his ill-fated yachting attempts a couple of times and had to be rescued at a cost of millions of dollars. Public opinion was divided but generally sided with him, our government justified the cost because it was good training for the navy and airforce, and Bullimore made good money from book deals etc. To me he was just self aggrandising idiot trying to commit suicide by yacht.

What about people who try to commit suicide - clearly self inflicted! Why should we waste money trying to save their life? In fact lets only treat babies and young children as they are the only people we could categorically say have illnesses that aren't self inflicted - or if they are, they really aren't "responsible" for it.

My mother was an alcoholic and died of liver failure in this week in 2008, in an intensive care bed after emergency surgery which I know very rarely saves lives. She is the easy target who sometimes gets pointed at.

She was a successful university lecturer who paid tax, worked hard and brought up three children alone. She struggled all her life with severe depression as a result of sexual abuse and rape by more than one person as a child.

She did try to get help continually throughout her life, both paid for by herself and through the NHS. None of the help helped her with her depression and sense of trauma. She struggled continuously with the desire for death to end her pain. In the end, she didn't believe she could be helped. In the last ten years of her life she drank to hep her get through the day.

She was an incredibly beautiful, intelligent, useful member of society. She was also deeply troubled, could to find the help she needed. I don't know if it exists. We spent thousands and thousands trying to find it for her. It was far from easy to be her child. She drank to self-medicate herself from pain. It was awful for us and for her.

I do think she deserved treatment on the NHS. I only wish it could have been treatment that would have actually helped and not just helped her in her death.

Alcoholics can recover. She didn't find in herself what she needed to do so. i wish she hadn't been an alcoholic and so did she, though cerly not enough.

sorry for typos.

Latrucha, I found your post very moving and I think it helps to illustrate the complexity involved when we try to decide whose illnesses are self inflicted