There is quite a controversy brewing in Britain and it concerns “Healthy Choices,” or you could term it as the consequences stemming from unhealthy choices. The British National Health Service (NHS) is bringing forth an agenda that patients who are obese or are smokers, and who wish to have hip or knee operations, must be required to wait for months to change their ways. It is called “lifestyle rationing.” Obese patients and those who smoke, will essentially be required to change their ways. In essence, the obese must go on diets and smokers must cease smoking.
The NHS does not care if the patient is in pain or cannot walk. They want a “drying out period,” in a sense. In that period the patients can mend their ways; they can go on diets and stop smoking. Sound good on the surface? Maybe not so fast. The ethical choices and consequences of our health habits?
Protests
Let us first establish that the British National Health Service was created to meet the medical needs of the vast majority of patients who cannot afford private treatment. It is a fundamental principle. The alternative to the NHS is private treatment which, like in this country, is quite expensive. Many of the wealthier patients will get fast treatment and relief while the “poor,” especially the poor who are deemed obese or smoking too heavily will wait.
The term for the NHS decision is “rationing.”
Britain was very proud of the NHS, the idea was to serve everyone equally, but these new policies will create a giant fissure between the “have’s” and the “have-not’s.”
The latest statistics show that about 20% are now being denied knee or his replacement surgery. For example, in Scarborough, Ryedale and Yorkshire, 79 out of 408 patients needing a knee replacement have been told to lose weight or stop smoking during the delay – which now has the spiffy new name called “health optimization.”
The criteria are arbitrary. For example, if you are seen as being obese, no matter how much pain you are in, you will not get a new knee until you lose weight. The problem is that a 78-year-old man who is deemed obese, cannot climb aboard a treadmill or an elliptical machine to exercise because of the pain!
Critics are calling this policy a form of discrimination, and the trend appears to be growing. It is an ethical value judgment, with the healthcare bureaucracy being the judge and jury.
Should people lose weight or cease smoking? Of course, they should, but a national healthcare system with an arbitrary set of rules in place should not be judge and jury. Patients do not replace joints because they whimsically want to get cut upon! They live in constant pain and need relief. There are value judgments in place here that are outside the scope of the NHS. 
Where Could It Lead?
If healthcare delivery is problematic in the U.K., it is an absolute maze in America. We have no comprehensive system. We have a patchwork quilt of plans and competing politics. What we do have is a middle class getting squeezed, judged, forced into ever-higher premiums and having to pay, in essence, for those who have no resources at all.
Suppose restrictions were not just put in for the obese or smokers, but for those over 80, or too young, for pre-existing conditions, for different racial or ethnic groups and on and on? Where does any of it stop?
The NHS is viewing their stance as a victory for preventative medicine, to my view it is the opposite.
I well remember a community fight we had in my neighborhood where “activists” were protesting a fast food restaurant. They made the argument that the food was unhealthy and the trash (the wrappers and cups) from the operation would mess up the scenery. Yet, not more than a block away, a national chain coffee shop, serving among other offerings, 500 calorie drinks was being constructed and hardly a peep was heard. Ironically, both got built. The fast food establishment has assigned a crew member to constantly clean up around the building, while the coffee shop’s refuse pails are always filled to overflowing.
If we are going to apply medical ethical standards to universal health care treatments in the future that is an issue needing to be equally and rationally applied. It should not be subject to personal bias. The ethical choices and consequences of our health habits?
-YOUR COMMENTS ARE WELCOME!
