Medical Care and Voluntary problems

[Boyish-Tigerlilly]

What is your take on giving free medical care to people who deliberately caus e their own illnesses due to their own negligence or stupidity? Is it ethical to use resources that can go to help people who are unfortunate, on people who cause their own problem repeatedly? (Note, this does not take into account dependents of those who cause their own problems).

It seems a problem to me to take care of people who are intentionally harming themselves. Would it be better to restrict care to individuals, when such care would come as a result of their own unhealthy, negligent actions, but keep them under care if it's not their fault (accident, illness, etc).

[Boyish-Tigerlilly]

Edit: Sorry..

I just wanted to add that I know they do something similar to this already near me. They tend not to give transplants or organs to people who deliberatly damage their organs through their negligent actions. Apparently, the hospitals/doctors don't see them as reliable.

[Boyish-Tigerlilly]

There there do seem to me to be some problems with this, namely the concept of dependents and contributions to society. If they die, they cannot work or contribute to the economy. However, another problem is that it does not seem very compatible with the system of current government. It could be abused, sort of like in the eminant domain issue. On one hand it seems more fair, but on the other, it does seem like the same argument for "better use of resources and could be perverted to harm individual rights in other, unrelated areas.

Afterall, there are many things people do that are possibliy less resource efficient. You could do much more in another area with the resources people use in some other areas.So that argument doesn't seem politically applicable. It might be concieved as too authoritarian. Could that be a problem? If so, it seems also that even if something is ethical, it's not paractically applicable in every society.


This always bothered me. A lot of ethics just don't seem in sync with reality. No one wants to apply them.

[FSTargetDrone]

Do you mean something like smoking which increses the chance of getting lung cancer (expensive to treat) or something like poor eating habits, not getting regualr exercise, etc.?

There are any number of behaviors one could say are detrimental, but I don't know how far you could take it, denying care to someone who by his or her action or inaction, damages his or her health.

[mr friendly guy]

I think it may depend what type of medical problem there it is. If the medical condition does not affect behavioural actions per se, eg alcoholics with liver cirrhosis, there is a limit in the types of care provided. That is we may relieve suffering, although if they want a liver transplant they have to make an effort to change the unhealthy behaviour (how they show they have "changed" is another topic).

If the condition itself leads to a risk taking behaviour, for example psychiatric conditions, where the patient's ability to make decisions is impaired, there should be a mental health act or something similar to allow psychiatrist to take them into psych wards for treatment or have community treatment orders as an outpatient.

I have no problems with devoting resources to the latter, although there should be limits to the former unless they demonstrate a change of behaviour.

[Broomstick]

What sort of self-inflicted harm are we talking about?

If someone gets their ears pierced and develops an infection, should they be denied treatment? I mean, a hole in your ear isn't necessary, they went out and had it done to themselves, it's their own damn fault they're dripping puss and running a fever, right? But it's cheap to treat an infection early.

What about cosmetic procedures gone wrong? Messed up LASIK and now you need a cornea transplant (very rare, but it has happened)? Tough shit - you don't need LASIK, you brought this on yourself, you pay for the transplant. Or maybe you shouldn't get one at all if there's a shortage of corneas.

How about a facelift gone bad? That can leave you with scars like a 3rd degree burn - but you don't need a facelift, it's purely cosmetic. On the other hand, if your face isn't reconstructed you probably will never hold a job again and be on the public dole for the rest of your life, which could be of normal length. Might be cheaper for society, in the long run, to pay for you to get your face fixed so you can go back to work and paying taxes.

A mentally ill person gouging out their eyes or cutting themselves up... self inflicted, yes, but we're talking about a person who is likely incapable of making good decisions or reasoning due to a malfunctioning brain. They self-harm is a result of organ disfunction. Might as well argue that an epileptic who falls down during a seizure and is injured in that manner isn't entitled to care because their action - falling down - injured themself and it's even due to the same root cause, a malfunctioning brain.

What if a sword-swallower messes up and needs emergency surgery on a punctured stomach or cut esophagus? But wait - they didn't intend to hurt themselves, it's an occupational hazard. Rather like race car drivers getting into crashes. They don't intend to hit the wall, but sometimes shit happens.

On what basis can you deny care to someone?

[Boyish-Tigerlilly]

What sort of self-inflicted harm are we talking about?

Oh good question. I should have been more specific. I was arguing in favour of universal health care programmes on another forum, and one person said to me that it is incompatible with the concepts of Freedom, Individiualism, and Rights, because you would be forcing people to pay for other people who smoke, are alcoholics, or those who deliberately eat unhealthy. It "wastes" resources that should go to help people who legitimately need it. I didn't know what to say, because I know there are a lot of Americans who have horrible lifestyles, which might make the process very expensive, and you can't prevent those lifestyles, because it would be authoritarian (smoking prevention, IE). So, I was talking about things like

A. Alcoholism
B. Smoking
C. Crack addicts etc.

People whose actions they know damage their body and will eventually cause resources to be devoted toward them when they could go to someone else who does not engage in such practices.

If someone gets their ears pierced and develops an infection, should they be denied treatment? I mean, a hole in your ear isn't necessary, they went out and had it done to themselves, it's their own damn fault they're dripping puss and running a fever, right? But it's cheap to treat an infection early.

It's good you brought that up, because I was thinking of a way to fix some of the absurdities it would lead to. But no, I wasn't thinking of those types of things. I was primarily thinking of things that people continuously do, knowing it will cause them to need medical care later, not something that might have an off chance of doing it, or through accidents. Like, when someone smokes, he knows what he's pumping into his body, and he knows there's an excellent chance it will do something.

What about cosmetic procedures gone wrong? Messed up LASIK and now you need a cornea transplant (very rare, but it has happened)? Tough shit - you don't need LASIK, you brought this on yourself, you pay for the transplant. Or maybe you shouldn't get one at all if there's a shortage of corneas.

How about a facelift gone bad? That can leave you with scars like a 3rd degree burn - but you don't need a facelift, it's purely cosmetic. On the other hand, if your face isn't reconstructed you probably will never hold a job again and be on the public dole for the rest of your life, which could be of normal length. Might be cheaper for society, in the long run, to pay for you to get your face fixed so you can go back to work and paying taxes.

A mentally ill person gouging out their eyes or cutting themselves up... self inflicted, yes, but we're talking about a person who is likely incapable of making good decisions or reasoning due to a malfunctioning brain. They self-harm is a result of organ disfunction. Might as well argue that an epileptic who falls down during a seizure and is injured in that manner isn't entitled to care because their action - falling down - injured themself and it's even due to the same root cause, a malfunctioning brain.

This is a good question. I was specificially targeting people who engage in practices which do not cause accidental injury, rather things that are obviously unhealthy lifestyles that they know will do damage, and that it's likely they will do even after giving them treatment. It just doesn't seem right to give lungs to smokers, who will only smoke again. I think the rate of return smoking is pretty high, from what I saw at Foxchase.


As you mentioned, accidents I don't think warrent denial of treatment, nor do diseases that are not the fault of the person, or illnesses. I think you would have to know you will incur some illness or injury from what you are doing, but just not care, because you know someone else will pay for it.

[Boyish-Tigerlilly]

Then again, this solution would be completely irrelevant anyway if the person had dependents, since you would be effecting more than just the one person. I don't think it would be right to punish people who did nothing wrong.

[Lord of the Abyss]

The problem is, your really open the door to let the government monitor and run every last detail of your life. Do you really want to have to report every meal you eat, and have your health care docked if you eat anything but the most scientifically ideal foods ? Everybody does something that can labeled self destructive, because everything we do hurts us at least a little.

Fun activities are notorious for being unhealthy; a rule like you propse basically makes fun forbidden.

[Boyish-Tigerlilly]

I woudln't know what to do otherwise. I wouldn't want it so things fun were forbiden. For example. I wouldn't want people who got sick/injured as a result of an accident to be penalized. Only people who suffer from things that aren't accidents that they know they were gonna cause by doing it, given that the injury was not an occupational hazard.

I don't think you should be able to eat McDonalds every day and expect people to pay your medical bills when you get sick. How do you also solve the obesity problem in the United States? You can't make people eat healthy, but then they end up being fat, lazy slobs. To me, it does not seem that many Americans (not all, though), are capable of responsible behavior in those areas.

[Boyish-Tigerlilly]

It would also probably be a matter of a degree, I think. It just doesn't seem ethical to take smoke and then take care from others. They are one reason why people don't want Universal Healthcare here. I always hear that excuse. It seems they are ruining it for everyone.

[wolveraptor]

I'm somewhat oppossed to having the government pay for a smoker's lung cancer treatments, but you can't stop people from smoking without being overtly authoritarian. The fact that this smoker can't pay also probably indicates that he isn't contributing to society in other ways. On the other hand, many insurance companies reject smokers, making it harder for them to pay their own bills. Perhaps we should cut them some slack. After all, they may have grown up in an era when people didn't even realize that smoking was bad.

[Darth Wong]

The idea of deliberately denying care as some kind of moral statement strikes me as immoral. However, given limited resources, it would make sense to prioritize care to those who did not cause their own problems. For example, if someone has suffered some kind of injury to his liver and needs a transplant, I'd tend to put him ahead of an alcoholic with cirrhosis on the transplant list.

[Boyish-Tigerlilly]

The idea of deliberately denying care as some kind of moral statement strikes me as immoral. However, given limited resources, it would make sense to prioritize care to those who did not cause their own problems. For example, if someone has suffered some kind of injury to his liver and needs a transplant, I'd tend to put him ahead of an alcoholic with cirrhosis on the transplant list.

That's what I mean. Somthing along those lines. The person who is the alcoholic will probably just screw up the transplant anyway. I know it works that way with Lung transplants. My gradfather had cancer, and he got the lung because the other candidate was a chain smoker.

[Mr. T]

If I was the sole doctor in the ER and 2 patients came at the exact same time needing the exact same organ. And one had an injury or condition requiring the new organ, whereas the other person needed the organ due to a reckless lifestyle, I would more than likely give it to the person whom damaged their organ through no fault of their own.

[Broomstick]

But - but - that's a form of rationing!!!!



Of course, when demand exceeds supply you always get some of rationing. Either the price goes up or some other mechanism comes into play. There has alway been "rationing" of scare resources, and always will be.

In truth, such criteria as whether the recipient can be trusted to care for their new organ does come into play. An active alcoholic will probably not be offered a new liver under any circumstances because they simply can't be trusted to take care of it. Someone who has been sober two or more years might be given one, because they've demonstrated some ability to control their problem.