Social Question

Charles's avatar

Should doctors be allowed to refuse non-emergency treatments to patients unless they lose weight or stop smoking?

Asked by Charles (4786 points ) April 29th, 2012

“be allowed” are the key words.

Question prompted from this article:
http://vitals.msnbc.msn.com/_news/2012/04/29/11452500-in-uk-survey-doctors-support-denying-treatment-to-smokers-the-obese?lite

“A majority of doctors in a United Kingdom survey supported measures to deny non-emergency medical services to smokers and the obese, The Observer newspaper reported Sunday.

Although the survey by the networking website doctors.net.uk was a self-selecting poll, the site’s chief executive called the response “a tectonic shift” for the profession.

The results feed into a British debate about “lifestyle rationing” by the National Health Service, the Observer reported.

The survey by doctors.net.uk, which claims nearly 192,000 members, found that 593, or 54 percent, of the 1,096 doctors who participated answered yes to this question: “Should the NHS be allowed to refuse non-emergency treatments to patients unless they lose weight or stop smoking?”

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29 Answers

marinelife's avatar

Doctors should not be allowed to refuse treatment to anyone.

chyna's avatar

No. They took an oath to help others. They shouldn’t judge. I’ll bet over half of them are obese or smokers themselves.

creative1's avatar

Why so no one can encourage these people to get a healthier lifestyle. This is a definate NO for me. Doctors are there to help people get well and not sit in judgement of how someone lives thier life.

SuperMouse's avatar

Doctors should absolutely encourage patients to maintain a healthy lifestyle. They should not judge patients that do not. It is isn’t up to the doctor to decide who deserves non-emergency care and who doesn’t.

tom_g's avatar

Obviously, they need to provide care regardless of how unhealthy a person’s lifestyle is. The “don’t judge” thing I strongly disagree with, however. Doctors are supposed to judge. If I walk in to my doctor’s office 150lbs overweight and complaining that my toes are gangrenous due to advanced diabetes, is s/he supposed to say, “Oh, we’ll just help you get those toes off and then put you on insulin and other drugs”? First, the doctor should – if they were the least bit concerned about my health – sit me down and try to address my health problem. The toes are not the problem – they are a symptom. U.S. healthcare treats symptoms. There is a serious trend in medicine to spread the “don’t judge” attitude, which does nothing but fatten the profits of pharmaceutical companies.

Doctors must treat everyone. I’d just like to see more causes treated rather than the symptoms.

Coloma's avatar

No, that is beyond bias. What about alcoholics and people with chronic anger issues that have high blood pressure and rotting livers? What about people that contract STDS because they are sexually indiscriminate?
While being overweight or smoking is clearly not ones highest choice these are both issues that are highly visible, not hidden like closet drunks, druggies and sexually addicted types.
Smoking IS an addiction and is very hard to quit, and where do we draw the line with peoples weight? At 20 lbs. 30 lbs. 50 lbs.?
Plenty of relatively healthy people struggle with moderate weight gain in their lives.
I cry bullshit, if you’re going to penalize one group of people then you must put in place criteria for others.

I’ve smoked, so what…if I come down with cancer 10 years after the fact should I still be refused treatment? Plenty of pots calling the kettle black IMO.
People have their vices and habits and no one is any better or worse than another. A smoker or overweight person is no better or worse than an angry alcoholic or someone addicted to pain killers.

I agree with Tom, treat the cause not the symptom and unless one is perfect don’t cast stones.

filmfann's avatar

I am trying to imagine what non-emergency treatment they would deny to someone who smokes or is overweight…
Are they not going to prescribe anti-inflamitories to someone with Brusitis?
Are they not going to give a colonoscopy to someone who is overweight?
Are they not going to check someone with an ear ache?

woodcutter's avatar

Docs should stay out of politics. Their opinion isnt needed for them to do their jobs. Maybe in England they don’t make enough money so it’s better for them to lighten their work load there.

bkcunningham's avatar

According to the MSNBC story @Charles linked, @filmfann, ”...Doctors who approved gave a few examples, The Observer said:

“Denying in-vitro fertilization to childless women who smoke was justified because the procedure was only half as successful for them as for non-smokers.

“Obese or alcoholic patients should be expected to change their behaviors before undergoing liver transplant surgery….”

The whole controversy is related to rationing of healthcare based on lifestyle in the UK because of the lack of funding. Americans should take a serious look at the ongoing issues surrounding healthcare in the UK. The British Medical Association wants the government to be willing to accept the responsibility of rationing. They are asking the government to set a national policy regarding what treatments should be restricted on their NHS.

john65pennington's avatar

This may violate their Hipocratic Oath. This is just their opinion and not fact, right?

Kardamom's avatar

No, those people need medical assistace not tsk-tsking.

It would be better not to give medical treatment to people who abuse their spouses, or who rape people or ones who are just plain mean.

I’m kidding, but I think you get my point. Doctors take an oath to treat people who need medical assistance, they are not paid to decide which people are naughty and which ones are not (and as some of the others have pointed out, sometimes it hard to tell).

gravity's avatar

Oh my… I should hope that never happens. “Let me see if you are worthy of my help? hmm..” Myyyy goooodness.

Coloma's avatar

@gravity Spot on!
Right, and just what almighty “perfect” being will be in charge of making these distinctions of worthiness?

Only138's avatar

LOL.
If you’re a fat smoker, you’re fucked. LOL
Doesn’t quite sound fair.

MollyMcGuire's avatar

Yes. A doctor should be allowed to not accept a patient just like a lawyer can refuse to accept a client. However, I do not think the patient’s insurance should refuse to cover a surgery on the condition of weight loss or behavior modification, unless the surgery would be dangerous without the modification. I MOST CERTAINLY do not think the government should be making that decision either (but that’s coming).

This is going to become much much much more prevalent in the USA.

SavoirFaire's avatar

No. Doctors have a professional responsibility to treat the patient in front of them no matter what. This is not to say that they must take on every patient who asks: if they have good, non-discriminatory reasons for rejecting a patient who is not in critical condition, then it is their right to as a free person to refuse to take them on (and if their reasons are discriminatory, the patient would likely be better off with someone else). Still, this is not sufficient reason for refusing treatment to someone who is already a patient.

I agree with @tom_g that doctors must not let worries about coming off as judgmental prevent them from giving medical advice about things like smoking or overeating. That said, part of being a good doctor is knowing how to do so effectively. Moreover, a doctor is not a dictator. Patients have a right to refuse medical advice and to have their own set of goals. Doctors should help the patient in those goals so long as doing so does not violate his professional code of ethics.

If a patient refuses to use steroids as part of their treatment, for example, the doctor needs to know how to work around that (if at all possible). Berating the patient for not having the same views about what is or is not acceptable to put in one’s body is simply counterproductive. You take the patient you’ve got and you go from there. I worked with a great group of doctors for several years, all of whom were capable of adapting to the different of needs their various patients presented. It doesn’t seem that much to ask.

Coloma's avatar

This Q. has really stimulated me to look around out in my daily travels. Just a little while ago I was in line at my bank and just observing people. There was a very nice looking older guy in front of me who could probably stand to lose 50 lbs. I was thinking, ” so is he not deserving of treatment?” I then saw a young guy smoking a cigarette in front of a store, he was a really nice, open person, rushed to hold the door for me.

Ya know…live and let live. I’ve known plenty of health nuts that have all sorts of shitty personality factors and hedonist types that are the nicest people ever.
I’d much rather befriend a really decent human being with a bad habit than a health freak with an arrogant attitude. Bah!

bkcunningham's avatar

@Coloma, it would be a shame if happy brownie users were restricted from receiving certain medical care.

Coloma's avatar

@bkcunningham Darn tootin’, we’re usually a pretty sensitive and all inclusive bunch. lol

lonelydragon's avatar

No. I’m pretty sure that would violate the Hippocratic oath.

@tom_g Of course they have the right to advise their patients to change their habits, but when the doctor is obese himself and yet he’s lecturing his patients about their weight, that doesn’t set a very good example. Such a person would lose credibility with me pretty quickly.

bkcunningham's avatar

One of the best surgeons I’ve ever known told my ex-husband he needed to stop smoking. He said this with a pack of Kools in his pocket. When my ex made a remark about he wasn’t going to take advice from someone who smoked, Dr. Desy said, “I didn’t say I was perfect. I’m just telling you the facts. Plus, I’m not the one with blood pressure so high I’m ready to have a stroke.”

MollyMcGuire's avatar

@SavoirFaire You are wrong about medical doctors’ professional responsibility. The OP asked about non-emergency treatment.

tom_g's avatar

@lonelydragon: ”@tom_g Of course they have the right to advise their patients to change their habits, but when the doctor is obese himself and yet he’s lecturing his patients about their weight, that doesn’t set a very good example. Such a person would lose credibility with me pretty quickly.”

First, I’m not talking about “lecturing” – I’m talking about treating. To go with my example, there seems to be an understanding that you treat the symptoms of diabetes rather than the cause. This certainly makes sense in the U.S. because there is a ton of money to be made if we ignore the cause and keep treating the symptoms. The “don’t judge” impulse is (in my opinion) the misapplication of a good impulse. Of course we want a society that is less judgmental and more accepting. But how does this apply to a person who is tasked with helping us get healthy?

So, back to my example…Let’s say I’m 150lbs overweight, I have developed diabetes as a result (along with a ton of other health problems), and my toes are gangrenous. The job of the doctor should not just be to cut off my toes, put me on insulin and other drugs ($$) and send me on my way with a smile. The cause of my deteriorating health is my excess weight. This is treatable and should be addressed.

If doctors can’t address a person’s obesity, I can’t imagine what good a doctor is at all. Why not just call them “the middleman” between the pharmaceutical industry and its customers. It’s more of a business profession than a health profession in that case.

So back to your concerns about being “lectured” to by overweight doctors. I’ve covered why I feel the term “lecture” is not the correct term here. Addressing weight = addressing lifestyle = the whole point of a doctor in the first place. But as to your concern that the doctor may be overweight himself/herself: I’m not sure how this comes into the picture at all. If the doctor has knowledge on how to be healthy, conveys this to you and works with you, what does it matter if the doctor is not following his/her own advice? The advice is either correct (leads to better health) or it isn’t. The messenger’s acceptance of the advice into his/her own life says nothing about the advice itself.

SavoirFaire's avatar

@MollyMcGuire You’ll note that I didn’t use the word “emergency” once in my response. If someone is already a patient, it is assumed that their doctor will help them. The doctor would need a very good reason to refuse treatment. That is the essence of what I wrote above.

lonelydragon's avatar

@tom_g I suppose that “lecturing” was the wrong word. And I’m not saying doctors shouldn’t address obesity at all. Of course they should prescribe changes in diet, lifestyle, etc (so I don’t think our opinions on this issue are as divergent as they may seem). But I also don’t think it’s too much to ask for them to follow their own advice and model that good behavior for their patients. It inspires confidence in patients when their health professionals are healthy themselves. If the doctor is overweight him/herself, then the patient is more likely rationalize their own troubles with weight (for more information, see this study). Also, a discouraged patient may look at the doctor and think, “Well, s/he is a health professional and s/he has not been able to resolve this health issue. What hope is there for me?”

Charles's avatar

Sort of related:

”...laws in more than half the states permit insurers to deny payment for medical services related to alcohol or drug use and that can derail hospitals’ best intentions, experts say.”

http://vitals.msnbc.msn.com/_news/2012/05/01/11475906-er-visits-after-drinking-may-not-be-covered?lite

Coloma's avatar

What about Veterinarians? My cat Myles in my avatar is a very BIG boy, he likes his Fancy feast, should he be refused treatment because he’s a fat cat? lol

MollyMcGuire's avatar

@SavoirFaire You said no matter what. That left if wide open for anything.

SavoirFaire's avatar

@MollyMcGuire I think you’ll find that reading the entirety of a post, rather than merely the first sentence, is important. It gives you things like context and a full understanding of what was said. I highly recommend you try it in the future.

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