Providing Medical Procedures to Patients with a Questionable Lifestyle - Essay Example

Topic: Any Patient Whose Poor Health is Self-inflicted Should be Given Lower Priority When it Comes to Allocating Healthcare Resources IntroductionProviding or restricting healthcare to patients with poor health due to a self-inflicted lifestyle should be based on sound criteria that is medically permissible and not based on ethical or moral standards that would make doctors decide the punishment on those who are perceived to be immoral by society (Wilkinson, 1999). The primary purpose of prioritisation is to ensure that excellent care amongst the population is uniform and non-discriminatory. However, there are patients that have habits that need to be corrected through their lifestyle because the primary symptoms they are exhibiting are bad side effects of their adopted lifestyle (Greener, 2008). Therefore, the prioritisation standard when it comes to healthcare should include the criteria that will ensure that the resources provided to patients with questionable habits or lifestyles should not go to waste. The moral dilemma of providing medical procedures to patients with a questionable lifestyle is more pronounced in cases where organs are to be donated. The recipient of a donated organ is not only expected to pass strict criteria to ensure that the organ will not be rejected by their body; they also need to present tangible and convincing proof that they are not engaging, or have not engaged, in any activities that could potentially waste the opportunity presented by the donated organ to save lives or to elevate the quality of life of another patient. The presence of other diseases or medical conditions in the recipient that could shorten or lengthen his or her life is also taken into consideration (Corley et al., 1998). Be that as it may, there is no clear-cut universal criterion that is being used in the medical profession (Corley and Sneed, 1994). The medical profession uses triage to prioritise patients in times of emergency, most especially when medical resources are scarce, to ensure that medical care is given according to the severity of the patient’s condition (Manchester Triage Group, 2001). The methodology is not meant to discriminate but rather to ensure that practical prioritisation that would allocate resources according to the responsible determination of the patient’s actual condition is achieved. It should be noted that triage does not discriminate in any way, except to ensure that resources are allocated to those who are most likely to survive, rather than being allocated to patients who are still likely to expire no matter what medical care is given. The triage is based on information obtained or present at the time it is being conducted (Grossman and Aarne, 1999). In providing healthcare to patients whose lifestyle is adverse to the medical care being provided in a situation where healthcare is scarce, it is a matter of expediency and responsible allocation of resources to ensure that resources are not wasted. It is not a form of retribution that would give the medical profession the responsibility of punishing patients for their bad habits but rather a responsible allocation of resources that is historically accepted in the medical profession. The position is based on sound medical judgment that leads to the efficient allocation of medical resources when it is scarce (Glarum et al., 2009). This essay shall provide a rationale for a position that would not only limit, reduce or restrict the type of care patients with bad habits or questionable lifestyle choices have (Dranove, 2008). It will explore the legality of its arguments based on existing case laws and the law, and likewise present an opinion that is supported by the weights of its own argument, which is based on logic, established truths and the laws of the land. I) Identifying self-inflicted medical conditions or lifestyles that lead to medical conditions In the case of other unhealthy lifestyles that would include overeating, alcoholism, drug dependencies or any other kind of substance abuse, patients who indulge themselves in such lifestyles should be made to account for their bad choices. However, the manner in which the medical profession would restrict or withhold healthcare should be made within the ambit of prioritisation as provided for by law, if not a universally recognised process or criteria (Lefever, 2012). The recognised process should not be discriminatory nor should it be punitive. However, there should not be a situation wherein those who do not abuse their body are given the least preference against those who are abusing their body, then demanding medical care when their lifestyle takes its toll on their body. The key is how to set the types of lifestyle that are most destructive against those that are least destructive. a) Types of destructive lifestyle Rescuers, firemen, divers, soldiers and even law enforcers have lifestyles that put themselves in harm’s way every day. The intent and rationale of the people who consciously put themselves in harm’s way can be considered altruistic. However, their selfless dedication to their careers will put their body in danger. Should these people not qualify to get an organ? These types of people do not have a choice but to return to their chosen jobs; thereby wasting whatever donated organ is transplanted into the patient should the patient succumb to the types of destructive exposure these people face every day of their life. Restricting the criteria for the right to medical healthcare to include only those patients leading a healthy lifestyle will disenfranchise these types of patients with this particular lifestyle (Caplan and Coelho, 1999). It should be noted that aside from accidents, rescuers, firemen, divers, soldiers and even law enforcers do not develop any visible or tangible disease that would require maintenance or constant hospitalisation. These people’s lifestyles do not attack the body, causing it to disintegrate or form a disease. Their demand or need for medical health resources is not as taxing. In fact their lifestyles support and are even beneficial to their body. Meanwhile smokers, alcoholics and substance abusers are people who have the choice to stop their addictions and lead a normal and healthy life. There is evidence, though, that shows that addiction is a form of disease that can be treated with medicine (Harwood and Myers, 2004). However, the key element in addiction for the purposes of this thesis, is acknowledging the presence of the condition and the choice of seeking help to rectify the situation. Thus, it still boils down to the personal choice of the person to remain a smoker, alcoholic or substance abuser. Given the thesis presented by Hardwood and Myers, is it just for smokers, alcoholics and the like to be given an equal share of scarce medical resources and opportunities, together with those who do not have an addiction of any kind? The position is rooted in the equality of man and the duty of care demanded from the government to ensure that all sectors of its society are served. b) Medical conditions directly connected to destructive lifestyles Heart ailments, liver cirrhosis and different kinds of cancer are the primary risks that await smokers, alcoholics and other substance abusers. There are other ailments or combinations of them that eventually afflict substance abusers. Unfortunately, these conditions require a lot of medical attention and resources. The addiction, in fact, even prolongs the symptoms of curable diseases or medical conditions, thus requiring more medical resources. If the patients continue with their destructive lifestyles, their medical conditions will worsen, if not require more medication to alleviate the symptoms. Patients with destructive lifestyles drain scarce medical resources even more than necessary. These types of patient require more visits to the doctor and require more time to recuperate. c) Social impact of destructive lifestyles Soldiers and the like play an important role in society. However, alcoholics, smokers and other substance abusers not only test and abuse society, they also become a liability in society. In the case of patients who are obese or bulimic, their lifestyle does not harm or affect any other person except when their lifestyle takes its toll on their health. Heart failure is one of the leading consequences of an unhealthy lifestyle and it would be incredulous and morally questionable if a patient who smoked were given preference because of triage over a non-smoker patient. Smoking, while increasing the risk of heart failure, also increases the severity of any heart-related ailment, thus the very reason why the patient who smokes is given more preference according to the triage is because he is a smoker. Equality and discrimination have always been the measure in ensuring whether quality provisioning of any kind of resources has been effective or not. The absence of discrimination ensures that any kind of initiative is politically acceptable. However, if one patient is presented to a doctor, the doctor’s responsibility is to ensure that the life of the patient is preserved or saved under normal conditions. During emergencies, the doctor has the right to exercise his medical judgment if a triage is necessary in the situation. II) Argument for and against patients with self-inflicted medical conditions being given low priority in the allocation of healthcare resources Unhealthy lifestyles are avoidable; the power to change to a healthy lifestyle is within the ambit of the patient. It is most unfair for patients who are conscientious about their health to receive the same kind of healthcare benefits as patients who are not as conscientious. To illustrate: A smoker and a non-smoker both enter the hospital for heart failure treatment at the same time. Initial evaluation of the cases indicates that the smoker and the non-smoker would need the same kind of treatment and medicine; however the medicine needed by both of them is in short supply in the hospital. The important question to be asked is: What is the most logical way to handle the situation that is both just and in accordance with the law. a) Argument for patients with self-inflicted medical conditions The National Health Service in England has restrictions on medical resources for obese patients or patients who smoke due to the incontrovertible medical reason that they respond to medicines poorly until such time as they undergo rehabilitation and change their lifestyles. The logic is to manage scarce medical resources provided by the National Health Service to make them beneficial to those who need them most. It is also essential that medical resources from the National Health Service reach or benefit as many people as possible. However, the restriction imposed brings more questions that touch on the ethical and moral expediency of the restrictions imposed on smoking and obese patients. “What particular behaviors should lead to sanctions? How do we decide when a particular behavior is self-induced? If obese patients and cigarette smokers are to be restricted in their access to National Health Service resources, how about those with sports injuries or those who work as builders and have a high rate of occupational injuries?” (Lefever, 2012) Taken in another context, “Does someone suffering from anorexia do so deliberately? Or is there a defect in the neurotransmission systems in the mood centers on the brain? Is alcoholism a stupid weakness or an illness that is beyond the control of the individual? Is a drug dependent a depraved individual, coming from an inadequate background and under the inappropriate influence of peers, or someone who has a perception deficit that might even have a genetic link?” (Lefever, 2012) Wilkinson opined in his ‘restoration argument’ that effective management of medical resources should not be discriminatory in nature but should be based on sound ethical and moral standards that will ensure and uphold the constitution of the National Health Service of England. Providing medical care to patients with self-destructive lifestyles should not restrict, inhibit or even suppress the provisioning of medical care to patients with a non-self-destructive lifestyle. Thus, if there are enough resources, there is no reason to withhold or even restrict the provisioning of medical care to patients with self-destructive lifestyles (Wilkinson, 1999). Wilkinson also managed to formulate a logic that would promote the symbiotic relationship of patients with self-destructive lifestyles and patients with non-self-destructive lifestyles. He stressed that patients with self-destructive lifestyles manage to increase the allocated resources to diseases since the number of patients with self-destructive lifestyles tend to see the doctor more and even need more medicines than usual. He opined that patients with unhealthy lifestyles tend to get affected by their vices early in their life. Medical practitioners have the duty to provide treatment to patients who come to them to alleviate their medical conditions (R v Sheffield Health Authority, 1994). In general, the National Health Service constitution has declared the following as the mission of their existence. First “That the National Healthcare Services meet the medical needs of everyone”, second “That medical care is free at the point of delivery” and lastly that it be “based on clinical need, not the ability to pay” (Parliament of the United Kingdom, 2006). The National Health Services are therefore mandated to provide medical care to everyone when resources are available. Argument against patients with self-inflicted medical conditions The primary responsibility of the government is to manage its resources to ensure that the public in general, or all sectors of society, efficiently benefit from the resources provided to the government through the payment of taxes. Efficient distribution of resources means that no sector is disenfranchised due to the excessive demands of one sector due to machinations within its control (Tierney, 2006). It would be destructive and a disservice to the public if one sector were heavily favoured to enjoy the scarce medical resources due to everyone because it has chosen to adopt lifestyles that are inimical to its own health. There is a strong medical argument that indicates the inefficacy of medicines on patients with destructive lifestyles in dosages that are normally given to patients with healthy lifestyles. To illustrate: For drugs to be most effective, the computation of the correct dosage to be administered to patients should take into account his or her weight. For obese patients, the dosage would therefore be more. There are also some drugs that are contraindicated against alcohol and certain narcotic substances. The contraindication may sometimes lead to death, if not severe consequences for the patients. These facts do not discriminate nor do they restrict the medical care available to patients with destructive lifestyles. It is a fact of life that simply cannot be cured by simply making more resources available to that sector of society whose lifestyle is without regard for its own good (Mason et al., 2011). Medical and pharmaceutical limitations cast aside, it is an established parameter in organ donation to consider the past and present lifestyles of patients to ensure that organs are not transplanted to patients who are not likely to survive or outlive the transplanted organ. An organ being a very scarce commodity should not be wasted on alcoholics that would just infect the transplanted organ with toxins as a result of the consumed alcohol. Nor should organs be transplanted to smokers who have developed other diseases or symptoms of it due to excessive smoking for most of their life (Veatch, 2002). The argument about people with risky jobs and people with hobbies that are equally dangerous is defeated by the presence of defective organs that have been damaged over the course of time when patients with a destructive lifestyle are consuming or abusing dangerous substances. People with risky jobs should not be considered a risk or on the same level as those patients, who lead destructive lifestyles, since lifestyle is a choice that is consciously adopted by people. Thus, people with lifestyles that can be considered dangerous, for example those who take part in extreme sports, should qualify as organ recipients, and provided they commit to stopping their dangerous lifestyles. Athletes’ bodies are very well taken care of, thus they will not have the same damage to their organs as those patients who are smokers, alcoholics or substance abusers (Beauchamp and Childress, 2008). In his article, Lefever asks: “What about those patients whose substance addiction is considered clinical or as a result of psychological or physiological symptoms? The same arguments about the viability of the organs and the survivability of the recipient of the organ should be considered. The question of whether or not they are mentally or emotionally incapable of stopping their addiction in order for them to be worthy of organ donation is defeated by the survivability of the patient if the damage to his body from the addiction is considered” (Lefever, 2012). It should be noted that people with destructive lifestyles tend to contract diseases related to their addiction or lifestyle more frequently than those who do not, making them visit and consume the time of doctors more than those patients who engage in healthy lifestyles (Lefever, 2012). This translates to more medicines being given to patients with destructive lifestyles and depriving those who exercise and practise healthy living. In terms of the economics of health service contribution in the form of taxes, people with destructive lifestyles tend to get sick quicker and more frequently than those who practise healthy living. Their earning capacity is greatly diminished or less than those who practise healthy living and yet their demands for healthcare are greater than those who contribute more. Thus, it makes more practical sense to reward, if not take more care of, those people who live healthily than those who lead a destructive lifestyle (Pozgar, 2011). Restricting scarce medical resources or limiting the supply of available medical resources to patients with questionable lifestyles should not be construed as discriminatory. It is an effective management of scarce resources to ensure that more medical and health resources are available to patients where they can make more difference. Providing scarce medical resources to patients who will squander them anyway by living a destructive lifestyle should not bode well to people who manage those medical resources (Mason et al., 2011). It is not the position of this paper to suppress or limit the supply of medical resources to emergency patients. It is the position of this paper to provide proper guidance on how to manage scarce medical resources to ensure that they are properly administered to patients with the most need for them. For emergency patients, the main concern is still to restore life if not preserve life until such time that doctors are able to determine the medical history of the patient. This paper does not propose to withhold or restrict medical resources when there is an abundance of them. Triage, as practised during emergency situations, should also be practised in managing medical resources to ensure that they will not be wasted. However, a proper framework should be provided to ensure that the moral decision is not left to the doctor or health professional administering over the patient to restrict or to provide, if not commit, medical resources to a medical case (Manchester Triage Group, 2001). The framework as suggested herein should also serve as a guide to ensure that proper responsibility is assigned to parties who make the decisions. The Hippocratic Oath demands utmost fealty from the medical practitioner to save life. Modern society with its burgeoning population demands that resources in whatever form should be managed to ensure that all sectors of society get their equitable share. Management of resources is within the ambit of the politicians; alleviating malady is within the province of the medical practitioners. Legislating frameworks for medical practitioners to be properly guided on how to discharge their duties in accordance with the demands of equitable allocation of medical resources are needed (Mason et al., 2011). “The primary role of government should be to create the legal and regulatory framework, to ensure that access to high standards of care is guaranteed to all, and to ensure the supply of essential public health services” (Health Policy Consensus Group, 2003). The Health Policy Consensus Group also posits that healthcare should be taken away from the hands of politicians. The immediate and expedient reason is that politicians are not doctors who have the competency to cure what is wrong with the health system. However, politicians hold the purse strings and have the ambit of control over resources that are provided to patients. III) Conclusion At the moment, the reckoning point for the amount of healthcare benefits a person can avail from government health institutions is their availability. The court has, on several occasions, refused to give guidance on how to allocate the meager healthcare resources since it is within the competency of the medical profession or field to provide that very standard. The court has also opined that budget allocation to medical resources is subject to the availability of funds that can be given by the government, therefore the scarcity or the oversupply of medical resources is a political question and not a judicial question. There is, however, wisdom in legislating standards that would provide for the efficient allocation of resources that is just and equitable to all concerned. In providing the framework for a legislated standard that will govern the treatment of patients with destructive lifestyles, the following should be taken into consideration: For the non-punitive nature of the standard Wilkinson’s ‘restoration argument’ opined that in order for medical healthcare resources to be available to patients with non-destructive lifestyles, medical healthcare resources should be restricted or even controlled if not constrained from patients with destructive lifestyles. Wilkinson also posits that in order for the ‘restoration argument’ to gain ground or become more socially acceptable, it should be justified and argued with the strength of its actual intent. The ‘restoration argument’ is not meant to discriminate nor should it be punitive; the whole intent of the ‘restoration argument’ is to provide an equitable and just allocation of medical resources based on sound criteria. The standard should not go against the morality and ethics of the medical profession Life is precious, be it the life of a smoker or non-smoker, alcoholic or non-alcoholic etc. However, even in the medical profession, in times of emergency doctors are made to choose between patients who have the most chance of living and patients who are likely just to waste effort and the medicine given to them because they will die anyway. But the criteria used in triage in the case of emergency are established and widely used, have been proven to be non-discriminatory and are actually based on sound medical decisions. In the case of organ recipients, the medical profession, for its part, has instituted a standard criterion for organ recipients that would include scrutiny of their lifestyle to ensure that the organ will not go to waste and only be given to patients who want life and not to patients with utter disregard for it. Finally, the whole premise of the framework is to ensure that the legislated standard will not be used as a means to further decrease the allocated budget for medical healthcare resources. The framework should also not be used to discriminate on the basis of the lifestyle per se, but rather on the basis of sound medical judgment that would lead to the proper management of scarce medical resources. As indicated above, there are lifestyles that could also be considered destructive, such as extreme sports, but medically speaking these types of lifestyle do not damage the human body; they do, however, put the person in harm’s way. However, unlike smoking or any kind of substance abuse, lifestyles that promote extreme sports do not systematically harm the body, thus this should also be included in the framework that will be followed in the legislation of the proper management of medical resources. IV) References Beauchamp, T. L. & Childress, J. F., 2008. 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