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People injured whilst participating in extreme sports should not be treated by a publicly funded health service. Explain the reasoning behind this statement.  Suggest an argument against this statement. To what extent, if any, does the statement justify a change in public attitudes to personal risk taking?

The statement states that people who voluntarily take risks with their health because they participate in extreme sports such as sky diving cannot expect tax payers to pay for their medical care if injured. It is a statement regarding social justice[fairness] because health systems such as the NHS are cash limited so that funds spent on such people will mean that less money is available for treatment for others. In a private or insurance based health system people who take risks would probably have to pay a higher premium.

 A person’s autonomy has to be respected. They have a right to decide how to live their life and to do extreme sports if they wish. It is important to be non judgemental and act in the best interests of that patient which means treating injuries. If those participating in extreme sports are denied medical treatment for their injuries a slippery slope may be created in which those suffering from illnesses which may be in part also ‘self inflicted’ such as smoking or obesity related diseases may in future also find themselves excluded from state funded treatment.

At present ethical principles held by most, including the medical profession would value the principles of autonomy and beneficence over the idea that in doing so we would not be fair to others. The statement does put a valid argument to change attitudes to personal risk taking however because of the reasons outlined in paragraph two I disagree with a change of attitudes in this ‘rights versus responsibility debate.’    

vaccination

Parents who withhold vaccines from their children have betrayed their duty of care.
Write an essay in which you address the following points:
Why would parents withhold vaccines from their children? In what ways would doing so betray their duty of care? How can a doctor best advise a parent who is considering withholding a vaccine from a child?

Parents generally care very much for their children and are worried about any harm that might occur.There have been numerous scare stories about immunisations. The last major scare involved Andrew Wakefield who appeared to show a link between the MMR vaccine and autism and a bowel disease [Crohn’s Disease].However although the risk of harm is very low there are small risks involved. Vaccines like other medical treatments such as antibiotics are not 100% safe, 100% of the time. The risk of most vaccines is comparable with that of crossing roads for example and is about 1/10 of the life time risk of getting struck by lightning[seehttp://besthealth.bmj.com/x/static/514517/decision-support.html%5D

Patients usually have autonomy.In this case the patient is a child and does not have capacity to consent to a procedure. Treatment depends on obtaining proxy consent from someone with parental responsibility. The parents have the right to refuse to have their child vaccinated but they have a duty of care. But should parents have the right to make ‘wrong’ decisions’ for their children.
The doctor should advise that there is overwhelming evidence that immunisations are relatively safe procedures that protect populations effectively against the risk of serious disease. A hundred years ago most parents lost a child due an infectious disease. Immunisations have played as great part in the fight against infectious diseases as antibiotics.Reduced uptake of vaccination results in more cases of the disease. If vaccination rates fall below 95% there will be a loss in what is termed ‘herd immunity’. Herd immunity occurs when the vast majority of a population is so resistant to an infection that that infection is undetectable in that population. Those who can’t be vaccinated for medical reasons or those with reduced immunity such as cancer patients are thus protected from the illness. In the USA it is compulsory to show that a child has been vaccinated when it attends school because a non-vaccinated child can be a source of an infectious disease. It is not just your child that you are protecting when they are vaccinated but also others by contributing to herd immunity.

Vaccinations are an emotive subject for many parents who are anxious not to take any risks with the health of their children. Risks are unavoidable in life and the risks from vaccinating are small, certainly smaller than the risk from large numbers not being vaccinated.

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