The Vale of York Clinical Commissioning Group announced last week that it would exclude obese people and smokers from non-emergency surgery ..
There are 2 important arguments for this;
The first is clinical common sense. Obese patients and smokers are much more likely to suffer complications, in fact those that are classified as obese are 1/3rd more likely to die, so it is common sense to encourage them to lose weight before non urgent operations as surgery is more likely to be safer and more successful.
Cost – The CCG estimates obesity cost the NHS in the Vale of York £46m in 2015. The CCG has admitted that it is doing this as a cost saving exercise. It is discriminating against the obese – something that most doctors would regards as unethical.
Looking at this using the 4 ethical pillars [see my book P89]
Autonomy –People have the right to eat what they want and make unhealthy choices. It is hard to lose weight. Virtually all obese patients want to lose weight. It is also rarely a simple personal choice to be overweight. If we are judgmental and discriminate against the obese and smokers then perhaps the NHS should not treat people get injured skiing or horse riding as there are also risks involved in these sports. We can continue down the slippery slope and refuse to treat people who hurt themselves while drunk or have complications after unprotected sex or fall asleep while driving because of excessive tiredness. Many cancers are caused by life style choices. We would not deny patients treatment for cancer.
Beneficience – A doctor should always act in the best interest of their patient.
Maleficence -It may actually be best to encourage them to lose weight before an. Medicine has a high propensity to harm. Operations are less likely to be successful if overweight or if you are a smoker, complications are greater and you are more likely to die. .
Justice – This scenario is about distributive justice. The fair allocation of scarce resources.Why should valuable funds be used on people who wont help themselves some would argue? The obese require more operations such as hip replacements, these are likely to be more complicated because of their size and other morbidities such as diabetes. If they want tax payers to fund their operations surely they should make an effort and lose a bit of weight?
Increasing obesity rates, new treatments and the ageing population are putting strains on health care in all developed countries. There is a limited budget for the NHS. It cannot fund all treatments for everybody. However politicians like to promise much [such as providing routine medical services 7 days a week]. The concept of rationing is avoided as it does not win votes.