To think we shouldn't be funding this on the NHS?

[AgileJadeDog]

I recently had my first stay in hospital due to a respiratory issue and I kid you not, every other person in the bay smoked+had a smoking related disease.

I have no idea if this is typical in other specialties/hospitals but it really hit me how much gets spent on completely self inflicted stuff. AIBU to think we shouldn't be funding stuff like this?

You also have to take into account the inks between poor mental health and then substance abuse (including diet related too) - so if someone has been failed by mental health services so self medicates do we fail them again?

you are taking a very simplistic view of a much more complex issue

We seem determined as a point of principle to not expose anyone to the costs of healthcare so this is the natural outcome.

Personally if we're excluding anyone I'd pick marathon runners and health food junkies - anyone impolite enough to live past 90 has a way bigger impact on the NHS than someone dying of a heart attack at 50...

It’s absolutely none of your business what other people are in hospital with. Mind your own business unless your perfectly happy for people to know the ins and outs of your medical condition.

OK, so where do we draw the line?

Fell down a flight of steps - didn't take enough care.

Heart disease - ate too much shite. Same for type 2 diabetes.

Chopped finger off - should've taken more care.

Sprained ankle when drunk - self inflected by being inebriated.

Imagine what might happen to the work force, if the vast majority of the above people were not able to afford private health care?

I feel sorry for everyone else on the ward having you staring at them long enough to know everything about their lifestyle and judging them for it while they're trying to recuperate.

I don't disagree with you, but where do we stop with this argument

• high BP and heart issues related to smoking or overeating
• mental health issues related to drug use
• skin cancer from using sun beds
• sports injuries

When you think about it, even pregnancy is 'self inflicted'.

Everyone makes mistakes, as health professionals our role is to treat, not judge.

However, I do get frustrated when people don't show up for appointments or don't follow advice, and then moan at us that they are not getting any better.

And those that abuse the system, such as getting a liver transplant and then continuing to drink alcohol, or lung transplants and then smoke. These are a precious gift given by a family at a time of grief, and to abuse this gift is unforgivable, not as a health professional, but on behalf of the grieving family.

So you think I should have told the NHS to let both of my parents die breathless and in pain? Nice!! My mother is my only remaining parent now, and no longer smokes. She vapes instead, at the suggestion of NHS doctors.

Of course it is self inflicted. So are sports injuries, car accidents, other accidents too. So are some illnesses if you don't look after yourself properly.

It really is not as simple as you seem to think. Many of these people also paid into the NHS all of their working lives, and in the case of my MIL (also a heavy smoker), worked very long hours in it. Should it have abandoned her in her hour of need because she was dying of a smoking related illness? Of course it shouldn't. That would be barbaric

Smokers pay lots of tax and they die younger which saves the money on pensions and long term care though, so it’s swings and roundabouts.

Fewer people die from smoking related illnesses than before yet health spending has exploded. Someone dying from lung cancer or COPD at 75 costs the NHS far less than if they died of Alzheimer’s at 90.

But wouldn’t that be a slippery slope? Some diseases COULD be related to lifestyle choices. But in some cases not. How would you distinguish them?
A smoker who admits to having smoked for 50 years and has lung cancer. Or the lung cancer patient who denies ever smoking. I smoked for 20 years. Have been quit for years. What if I lied and said I never smoked? Or do I get half the treatment funded because I quit?
Non smokers can also get lung cancer. How could you prove with zero doubt that it was the smoking that did it?

Should drunks not get treatment? For liver disease or what about broken bones from falling while drunk at 18?

Obesity can cause lots of health issues. Should all obese people just not be treated for anything at all in case it was the obesity that caused it? What about previously obese people who lost the weight? Who knows maybe that caused long term damage to their heart. Maybe that heart attack at 58 was caused by previous obesity despite the fact they’re now thin. So we shouldn’t treat that? What about obesity caused by other medical conditions? Shouldn’t be treated?
What about the person who grew up in care, had a terrible life, made bad choices like smoking and drinking, they should be punished by not having treatment for anything that could be (but still might not be) caused by those bad choices?

Time to withdraw free treatment for those who didn't eat enough food/nutrients to protect their bone density, then? Repairing broken hips and collapsed spines is just so expensive.

Doing anything which is very widely known to be harmful and can easily be avoided.

Smoking (it literally says on the packs you will get cancer if you smoke)
Obesity
Drugs
Alcohol
Extreme sports/irresponsible behaviour

The trouble is

1 - where do you draw the line on what’s self inflicted?

2 - what happens to those people? Just leave them to die?

irresponsible behaviour

Who is going to decide this?

My FIL has COPD (and I suspect silicosis) from working down the mines.

Is he worthy of NHS care or is that self inflicted as well?

How about all those with asbestosis from working in dockyards or construction?

If any of them have ever smoked, should they be banned from having treatment?

For many years the mantra has been, the most cost effective intervention any HCP can make is help someone to give up smoking., so I’m not convinced about the comment that smokers make a net contribution to the NHS.
The number of smokers had dropped considerably over the years, so tax take must have fallen.
my concern is Vaping- popcorn lung and all that.

There is no way of proving that a condition has arisen due to the obesity or the smoking. They may be risk factors, but there is no way of knowing if that individual would have developed that condition anyway – just as many non smokers and people of a healthy weight get cancers, respiratory illnesses, high blood pressure, heart attacks etc.

What is your criteria of illness and what is your method of extracting the people who have directly caused it?

Ridiculous idea.

Smoking (it literally says on the packs you will get cancer if you smoke)

I abhor smoking (and vaping for that matter), but that's not even true. It's not a given that you will get cancer.

Your attitude is downright nasty. Perhaps we should veto treatment for people who are bitter?

Charging people according to one's own personal behavioural barometer is one of those ideas that gets trotted out sometimes because people don't think, but doesn't survive even cursory contact with reality. It's just a really stupid, impractical idea.

You've not even said whether you want to deny people treatment altogether or provide it and then charge them. Both of these come with their own set of logistical issues and downsides, so it's important you at least give it some thought.

I think you are talking bollocks, and you are being a judgypants regarding people you really know nothing about.

Your reasoning is laughable.

Addiction is an illness in itself though. Do you object to the smoking cessation service provided by the NHS? I do understand where you're coming from but it's a very difficult stance to take because there are many grey areas. My sister in law has just been diagnosed with breast cancer. She is overweight (possibly obese, I'm not sure) and being overweight is a risk factor for cancer. So should she be refused treatment? Or told to lose weight before they treat her? This would likely result in her death. Obesity increases the risk of so many diseases that to take your stance you are basically saying the NHS should not treat obese people.

I used to work in ENT and we did sometimes refuse treatment if people wouldn't at least try to address their addictions. We had a few patients who were alcoholics and they were refused surgery if they were still drinking heavily. One was admitted but surgery was cancelled because we found he was sneaking off the ward to drink. So it does happen but not to the extent you are suggesting.

So one glass of wine at Christmas dinner and you can’t have nhs treatment?

how do you decide who is worthy?

it must be hard being as perfect as you obviously are!

About 15% of lung cancers occur in people who never smoked, OP. Some smokers would get lung cancer regardless of smoking status.

Same with T2 diabetes amongst the overweight, etc. How would you disentangle all of this?

This is aside from the moral dimension. I believe that health care is a human right. I might be looking at different models for providing it (universally), however

Exactly

Oh to be so perfect and sin free as you op.