6 ms·

To play a bit of devil's advocate here: At what point does a socialised health service with limited resources, stop providing care for "self-inflicted" injurie

• zbentley 9y ago
  I recognize the devil's advocacy and will refrain from judgement on your position. In response, there are a few options (probably more that aren't occurring right now; it has been many years since I was researching this in university): - A "need-blindness" system a la financial aid at US universities, as well as those in a few other countries. This gives deniability as its primary benefit, when people ask "why was the person with a 'self-inflicted' (replace those single quotes with very sarcastic finger wags, please) need above me?" That deniability is imperfect, and causes political problems. - A formalized ranking of factors that influence priority for care, performed by formulae as public and precise as possible. This could potentially include 'self-inflicted' conditions as something exerting downward pressure. Much like sentencing guidelines, there will always be some subjective/human leeway in the application of those formulae that draws accusations, founded or not, of bias. Also, in libertarian political climates, this will draw accusations of governmental meddling in personal decisions. - Pricing care at a level likely to ensure that only a number of patients proportional to available care-giving resources are admitted. This would require massive changes (mostly removals) to subsidies that exist for healthcare. This is unlikely to succeed politically, and from a humanitarian/ethical point of view is likely to be viewed extremely negatively (a view I share). It would have the advantage of making the "real" problem (lack of caregiving resources, including skills and general awareness) directly apparent, but only as a form of shock therapy. Those are ways to address your question directly and narrowly. Secondary solutions/those with knock-on effects (preventative care etc.) are out of scope of this answer. EDIT and as to the "when is it ethical" portion of your question (the above answers are logistical, not ethical), it's a crapshoot. It boils down to the ethical questions of the trolley problem plus the determinism problem, neither of which are generally considered to be tractable alone, much less together.
  • adwf 9y ago
    Thank you for the reply, I was a little worried that people would think the question too unpleasant and just downvote to oblivion! I was trying to think of explanations for the apparent callous nature of the emergency doctor who tried to discharge him from A&E and the nurses who gave equally brusk treatment. The first thing that came to mind was that they treated him effectively as a self-inflicted "slow" suicide case and it must be some ethical resource allocation issue. ie. hypothetically "Why am I treating this self-inflicted injury when there's a kid in the next ward who's been hit by a car and needs 24/7 monitoring"
    • DanBC 9y ago
      Those clinicians did that because they are unlawfully discriminating against someone with mental illness. And because UK funding for mental illness is so piss-poor there's not much service for those doctors to refer into. The lack of funding is a political choice, it's got nothing to do with the socialised nature of funding.
• zelos 9y ago
  Indeed, that's a dangerous path to start down. Something like 60% of the UK population is overweight: do we stop treating Type 2 diabetes because it's self-inflicted? It would save billions of pounds, after all. Personally I think people should take some personal responsibility for the NHS's under funding. We eat too much, drink too much, don't do enough exercise and drive dangerously - it's hardly surprising the health service is struggling. Edit: not that I'm suggesting Anorexia isn't a serious mental illness.
  • genzoman 9y ago
    Billions of pounds, are they really THAT overweight? (ba dum tsss)
  • tonyedgecombe 9y ago
    The biggest risk factor for most illness is getting old, you can't avoid that with a change in lifestyle.
• Klathmon 9y ago
  I think the analogy is a bit flawed. The whole reason they are there is the mental health issue, so denying them because it's not fixed is more like denying a person with cancer any more treatments because they haven't responded well to the first 30 treatments. A mental health problem is no more "self inflicted" than cancer is. It doesn't really change your ultimate question though.
  • adwf 9y ago
    Yeah, I think that the mental health part confounds the issue. When it's a chronic physical illness, it's a lot easier to give someone pills to take for the rest of their life. Whereas mental health is vaguer and potentially much more expensive. There are plenty of cancer drugs that the NHS will refuse to prescribe due to their expense. If you want them, you'll be told to go private. If mental health is so expensive, do we say the same thing?
    • QAPereo 9y ago
      It’s worth looking at patterns of homelessness and mass violence in the US before you take the leap. Mental illness can’t really be ignored, and untreated mental illness is dangerous for the sufferer, and the commmunity.
  • cryptonector 9y ago
    Is smoking an addiction? Is it a mental health issue? How about overeating (thus obsesity)? I ask because right now the UK's NHS severely limits access to healthcare for smokers and the obese. I think the more realistic distinction between anorexia/bulimia on the one hand, and smoking/obesity on the other -if there is a distinction in NHS's "mind"- it's that the former are more sympathetic. But I dunno, I'm just guessing. I have no idea what the mandarins at NHS and similar are thinking, or, rather, will think when their resources become even more constrained than they are now. That is, I suspect they (NHS) make choices about whose healthcare to restrict... entirely on the basis of a) scarcity / need to ration, b) how sympathetic a particular target group is. How else would they (NHS) make such choices anyways? how else could they make them even remotely palatable to the polity?
• klank 9y ago
  Why do you consider anorexia to be self-inflicted?
  • adwf 9y ago
    Personally I don't. I was trying to imagine the thoughts going through the doctors and nurses heads when he reported their apparent callous behaviour (turning him away from A&E, poor treatment on ward etc.)
• DanBC 9y ago
  Anorexia is a serious mental illness, and there is nothing that's self inflicted about it. ---Edit--- So, I think you're not saying it's self inflicted, but you're wondering if that's the perception that some health staff have, and if that's why they provide poor quality treatment. If so, yes, I agree with you. People with mental illness often find themselves at A&E. This is usualy because of their physical health - they are appropriately using A&E. (MH medication and illness can have horrible impact on physical health). But also people are often told to go to A&E if they're in crisis and not already under a MH team. That's not a great use of A&E and it's something we try to prevent, by providing better access to "crisis teams". ---end edit--- In the UK a considerable amount of money is spent on inpatient treatment for people with anorexia, and some of that is NHS funding of private for profit provision - for example Priory Group provide a lot of in-patient eating disorder treatment. The reason it's paid for is because people who are ill deserve treatment, and a death is usually more expensive to the state than the treatment. The reason so much private for profit provision is funded by NHS is because the NHS has underfunded mental health treatment for many years.
  • adwf 9y ago
    Yes, it's the perception that is concerning me a lot. To the physical doctor in A&E the prescription for anorexia is "1 cheeseburger daily" to which the patient says "no". To the doctor, this is then self-inflicted and less deserving of sympathy. I agree completely that the NHS is critically underfunded and preventative mental health treatment is the ideal course of action. I didn't mean to imply that completely refusing to treat is an option, more wondering if there's a point at which a doctor can turn around and say "You say no, therefore I say no".
• kemiller 9y ago
  Should we deny treatment to, say, skydivers or skateboarders? Race drivers?
  • adwf 9y ago
    No I don't think we should deny treatment to anyone; I wasn't advocating for that. The question is more, is there a theoretical end to care when the patient has failed to respond to treatment? Is there a point at which we prioritise those resources for someone else who is also in need?
• cryptonector 9y ago
  This is hardly an original thought. In the UK right now you cannot get surgeries from the NHS if you're a smoker or overweight. They've already made the leap you wonder about. And there's been talk of the same thing in the U.S. for Medicare. When you have access to private healthcare, you can decide where you draw the line (based on many many factors, including what resources you have, what resources you want to pass on to your children, etc.). When you don't, you're at the mercy of the state.
  • paulcole 9y ago
    >In the UK right now you cannot get surgeries from the NHS if you're a smoker or overweight This seems like such a broad statement that it can't be accurate. I'm assuming you're referring to some non-emergent and elective procedures, right?
    • cryptonector 9y ago
      http://www.telegraph.co.uk/news/2017/10/17/nhs-provokes-fury.. http://www.telegraph.co.uk/news/2017/10/17/nhs-provokes-fury.... > But the new rules, drawn up by clinical commissioning groups (CCGs) in Hertfordshire, say that obese patients “will not get non-urgent surgery until they reduce their weight” at all, unless the circumstances are exceptional. And what is "non-urgent surgery"? Who knows. If you need knee surgery, it's probably not urgent, but you may not be able to work without it, thus having very high social costs (unemployment, disability benefits, lost labor, ...) as well as very high personal costs. But NHS almost certainly doesn't have the resources even to consider the negative externalities of this policy -- they are acting out of desperation.
• gaius 9y ago
  stop providing care for "self-inflicted" injuries? It’s a question that won’t go away. In the UK the NHS spends £11Bn of its £125Bn annual budget on Type 2 diabetes. Diabetes UK reckon that 80% of cases of this condition are caused by or could be resolved by lifestyle choices. NHS underfunding could be fixed in, not overnight, but in a few months surely if those choices were made... and everyone knows it.
• pascalxus 9y ago
  I agree. There are some types of illness you can't treat yourself: those should be prioritized. This may sound a little callous: but all she had to do was listen to her body and eat more. And, unlike many illnesses, she knew what the problem was and she knew what the solution was.
  • FussyZeus 9y ago
    Spoken like someone who doesn't have a mental illness. Anorexics can fix themselves! All they need to do is eat! Depressed people can fix themselves! They just need to be happy! ADD sufferers can fix themselves! They just need to focus! Do you honestly think these things would be called mental DISORDERS if the solutions were this easy!?
• jdtang13 9y ago
  > My personal opinion is that the NHS is critically underfunded at the moment and that should be fixed first. Sounds wrong to me, but I know nothing about mental health in the UK. It's really hard to fix corrupted institutions without just restarting them from scratch. Throwing money at such institutions (in my opinion) tends to do more harm than good.