03-06-2003 20:40									#1
	Change your behaviour or you won't get medical help! Support Apolyton, buy Call to Power 2

OK, Labour didn't quite say this but they should have.

quote: Patients could have to sign up to healthier lifestyles under new plans being considered by the Labour Party. Written contracts would ensure a certain standard of treatment in return for people following doctors' advice and attending appointments

What's wrong with expecting patients to take a bit of care over their own bodies for once. It's no use turning up to a doctor at 45 having ate yourself into a heart attack. Responsibility needs to be taken earlier for one's health. If doctor's guidelines are not adhered to, certain treatments should be restricted.

http://news.bbc.co.uk/1/hi/health/2958148.stm

	03-06-2003 20:42									#2
	Help yourself to an AD-FREE life

One stipulation I would add to a Universal Health Care system is that one needs to follow doctor's advice when it comes to lifestyle changes. Although I believe health care should be free, a person needs to take responsibility when a lifestyle choice is the cause of your health woes.

	03-06-2003 20:53									#3
	Put an end to popups!

Lifestyle is the cause of the vast majority of healthcare woes in the developed world until you get to fairly advanced age. Traumatic injuries and non-sexually transmitted serious infectious disease is pretty rare.

	03-06-2003 21:02									#4
	Support Apolyton buy from Amazon

whAT aBOUT the SARS

	03-06-2003 21:12									#5
	Tired of ads?

quote: Lifestyle is the cause of the vast majority of healthcare woes in the developed world until you get to fairly advanced age.

The main ones can be easily pin-pointed - obesity (except where there is a diagnosed thyroid problem) and smoking are the main two that can be easily solved by enacting a responsibility to yourself.

Alcoholism is the next that is preventable but wouldn't be quite as easy to give up as smoking or excess food.

Sports injuries, DIY accidents are related to lifestyle but should not be a means to refuse treatment.

	03-06-2003 21:18									#6
	Support Apolyton or Terrorists Win

There are genetic pre-dispositions (sp?)... mind you

	03-06-2003 21:28									#7
	Support Apolyton, buy Alpha Centauri

quote: Originally posted by Boddington's Alcoholism is the next that is preventable but wouldn't be quite as easy to give up as smoking or excess food.

Technically nicotine is more addictive than alcohol, or even heroin. Many recovered heroin addicts can't quit smoking.

I think patients should be encouraged to take care of their bodies. I think this contract thing is a lot of additional paperwork for the doctors though. As they are under massive time pressure already I'd prefer them to spend more time with patients.

Just as a point of interest. Should the doctor deny treatment to a skateboarder who has broken their leg/arm several time and they've warned that if they go out again and fall it could damage them?

	03-06-2003 21:30									#8
	Enter the AD-FREE zone

quote: Just as a point of interest. Should the doctor deny treatment to a skateboarder who has broken their leg/arm several time and they've warned that if they go out again and fall it could damage them?

No. I believe that sports and activities are legitimate actions. When referring to lifestyle choices, I mean substance abuse and diet.

	03-06-2003 21:35									#9
	Tired of ads?

What's the difference? If skateboarding makes someone feel good and eating a chocolate bar makes someone else feel good why should one be punished for the latter but not the former?

	03-06-2003 21:40									#10
	Increase the size of your Attachments

Risk and expectation.

The chocolate-eater knows what he/she is doing to her body. The skateboarder who breaks his/her arm does so by accident.

	03-06-2003 21:47									#11
	Browse Apolyton AD-FREE

But the skateboarder knows that his activities carries a much higher chance of injury than other activities. Just like the chocolate eater knows he has a higher chance of obesity than a spinach eater.

	03-06-2003 21:48									#12
	Support Apolyton, buy Civilization 2

quote: Originally posted by MikeH What's the difference? If skateboarding makes someone feel good and eating a chocolate bar makes someone else feel good why should one be punished for the latter but not the former?

I'm not talking about eating a chocolate bar. I'm talking about eating 10 a day for 10 years and becoming an utter fat-ass. It isn't reasonable to expect national health care to support a bad diet. But, the same health care system should treat the fat if they make an effort to stop their lifestyle choice. The same with substance abusers.

Skateboarding is a physical activity, and different from substance abuse. Thus, treated differently. It's a hobby, arguably a sport, and people make their living off of it. The same with baseball, football (real football, not soccer), basketball, etc. When eating cheeseburgers and candy bars becomes a sport, a job, or a socially accepted physical activity, then you can use that argument.

And this isn't a question of punishment. It's a question of refusal to change behavior that the rest of the country is being forced to pay for.

	03-06-2003 21:50									#13
	Support Apolyton buy from Amazon

quote: Originally posted by Starchild But the skateboarder knows that his activities carries a much higher chance of injury than other activities. Just like the chocolate eater knows he has a higher chance of obesity than a spinach eater.

The knowledge of risk is irrelevant. In terms of risk, eating isn't a question of risk. If you eat 50 candy bars a day, you will become fat. If you drink 20 beers in one sitting, you will get drunk. Just because you skateboard, doesn't automatically mean you will suffer injury.

	03-06-2003 22:09									#14
	Put an end to popups!

quote: Originally posted by MikeH Just as a point of interest. Should the doctor deny treatment to a skateboarder who has broken their leg/arm several time and they've warned that if they go out again and fall it could damage them?

You guys lost track of the original context. The key is that a doctor has warned the patient of dangerous activity. In this context there is no diference between the scateboarder and the fat guy. The scateboarder is obviously scating in a way that is dangerous to his health. Normal scateboarding is not so dangerous that someone would repeatedly get injured doing it. Also, eating chocolate bars does not make you fat, but if you are fat you shouldn't be eating chocolate bars.

	03-06-2003 22:11									#15
	Browse Apolyton AD-FREE

unless you skateboard after eating 50 candy bars and drinking 20 beers

	03-06-2003 22:45									#16
	Remove this text

The context is that individuals are purposefully harming themselves by getting fat. Getting fat is a deliberate, slow process, that can be averted at any point over a few years.

Skateboarding accidents are just that.

	03-06-2003 22:47									#17
	Support Apolyton, pre-order Civilization IV

I'm agreeing with Bodds.

Also, the sheer number of obese related health problems pales in comparison to skateboarding accidents. The former definitely costs society and the people more money.

	03-06-2003 22:57									#18
	Support Apolyton buy from Amazon

Furthermore, everyone accepts some component of risk in their lives. Should we be denied medical treatment unless we wrap ourselves in cotton wool? No.

Should we be denied medical treatment if we knowingly and purposefully do things to our body that we know at the time are/will be detrimental to our health? Probably.

	03-06-2003 23:03									#19
	Support Apolyton, buy Alpha Centauri

Good thread topic. Touching on medical ethics.

Would you, as a doctor, refuse to treat someone suffering a heart attack at age 45 due to his lifestyle?

I agree, that doctors should not have to provide inappropriate medical services, even when requested by the patient. I also believe that a doctor has a responsibility to care for patients regardless of their situation. Would a homeless person deserve the same standard of care as someone more fortunate, despite the difference in their health and lifestyle?

	03-06-2003 23:04									#20
	Support Apolyton, buy Alpha Centauri

quote: Originally posted by MikeH Just as a point of interest. Should the doctor deny treatment to a skateboarder who has broken their leg/arm several time and they've warned that if they go out again and fall it could damage them?

I don't know about medical oaths internationally, but generally denial of treatment is a breach of medical ethics. The question should be limited for responsibility for costs.

When someone has chronic traumatic injuries at a particular site, or simply a history of injuries, then it is problematic - at some point, you're willfully saying "screw the consequences." In that case, I don't think it's fair for the taxpayer to subsidize your recreational choices, or bad luck or lack of skill at them. That's different from the occasional one-off sort of injury that can come from running, football, or what have you.

	03-06-2003 23:08									#21
	Put an end to popups!

They aren't going to make treatment conditional on patients sticking to the "contract" but I think this will do two things.

One - if your doctor says lose weight and you don't and then a surgeon refuses to operate because he can't hack his way through several inches of blubber you won't have any comeback for not being treated.

Two - if you are supposed to lose weight or quit smoking and then die in hospital of something smoking or obesity related your family won't stand much chance of a successful negligence claim no matter how incompetent the treatment.

	03-06-2003 23:10									#22
	Remove this text

quote: Originally posted by obiwan18 Good thread topic. Touching on medical ethics. Would you, as a doctor, refuse to treat someone suffering a heart attack at age 45 due to his lifestyle? I agree, that doctors should not have to provide inappropriate medical services, even when requested by the patient. I also believe that a doctor has a responsibility to care for patients regardless of their situation. Would a homeless person deserve the same standard of care as someone more fortunate, despite the difference in their health and lifestyle?

That's also complicated by availability of resources, probability of success of treatment, and improvement of quality of life.

If the homeless person requires a transplant, and has a history of IV drug abuse such that the vascular system is badly compromised, etc., then you have a different case from someone with a sound lifestyle, but a congenital defect of some sort.

In an ideal world where you had unlimited medical and financial resources, then it wouldn't be a problem. If you have to make life or death decisions due to shortage of resources, then it should be a matter of the greatest probability of successful treatment. That doesn't mean the guy who is the more "accepted" member of society or the less abusive in lifestyle, or the wealthiest. It means the one who is most likely to benefit the longest from the treatment, based on purely medical criteria, including psychological factors.

	03-06-2003 23:15									#23
	Support Apolyton buy from Amazon

In a marginal case, MtG, would you prefer to flip a coin or give treatment to the individual who has attempted to live healthiest?

	03-06-2003 23:23									#24
	Support Apolyton, pre-order Civilization IV

MtG:
Like I said, it's an excellent topic.

You are making the argument from scarce resources.

quote: probability of success of treatment,

Falls under my catchphrase, 'inappropriate treatment.' Appropriate treatment should have a reasonable chance for success.

quote: It means the one who is most likely to benefit the longest from the treatment, based on purely medical criteria, including psychological factors.

Another way to put this is to look at two people drowning, and you have time enough to rescue one. The only moral choice is to swim for the one you have the best chance of rescuing, to pull them out of the water. It should not matter the previous history of the swimmer when you try to save their life.

By your reasoning, we should always treat children or a younger person before older people simply because a successful treatment will benefit the younger person more than the older person.

However, we reach a different point when looking at services not needed to save a life, but to improve the health. If the resources are there, the doctor should treat the homeless person for the vascular disorder. If the resources are not, then we need to make some tough decisions as to which medical conditions take priority.

quote: improvement of quality of life.

Assumes a quality of life ethic, which has a huge parcel of other assumptions built up. How do we measure one life as worth more than another?

	03-06-2003 23:59									#25
	Support Apolyton, pre-order Civilization IV

quote: Originally posted by Soul Survivor unless you skateboard after eating 50 candy bars and drinking 20 beers

Heh. If you habitually shove that many calories down your throat before getting on, I think it's the skateboard that'll need help the most.

	04-06-2003 00:24									#26
	Increase Your PM Length

quote: Originally posted by obiwan18 MtG: Like I said, it's an excellent topic. You are making the argument from scarce resources. [quote] And when you get into advanced treatments such as bypass procedures, transplantation, and complex neurosurgery, as well as high-end oncology, those resources are scarce. [quote]Another way to put this is to look at two people drowning, and you have time enough to rescue one. The only moral choice is to swim for the one you have the best chance of rescuing, to pull them out of the water. It should not matter the previous history of the swimmer when you try to save their life.

In general, no. If you have fairly equal chances of saving either, but can't reach both, then you have some decisions to make.

quote: By your reasoning, we should always treat children or a younger person before older people simply because a successful treatment will benefit the younger person more than the older person.

Not necessarily. The child may require multiple procedures over time (heart-lung transplant), or may have less chance of surviving the procedure due to objective health issues.

quote: However, we reach a different point when looking at services not needed to save a life, but to improve the health. If the resources are there, the doctor should treat the homeless person for the vascular disorder. If the resources are not, then we need to make some tough decisions as to which medical conditions take priority.

Vascular degeneration from chronic IV drug abuse is untreatable. I was just using that as an example of a selection factor which is medically objective, instead of using subjective social value judgments.

quote: Assumes a quality of life ethic, which has a huge parcel of other assumptions built up. How do we measure one life as worth more than another?

We don't. Quality of life in this sense is an objective medical assessment, not a subjective social value assessment. For example, two patients need open heart procedures and pacemakers, but you only have resources to perform one. One patient has a fair probability of living ten or more years longer, and will be able to some extent to move on his own, to get out and do things, etc.

The other may live as long, but probably won't, and his only chance of surviving as long as the first patient is with oxygen, and ongoing treatment for other issues, requiring chronic hospitalization or some form of equivalent to chronic inpatient care.

What their families are like, or what either may or may not "contribute to society" doesn't enter into it, unless some particular factor (family members as monitors and caregivers) enters into the medical assessment of probability of successful treatment.

	04-06-2003 00:38									#27
	Suffering from ads?

This is a great topic.

I think it's fair that the government would increase healthcare tax on people who don't look after themselves.

(would get my ass in shape, too. )

	04-06-2003 02:19									#28
	Support Apolyton, buy Civilization: The Boardgame

quote: This is a great topic.

Thanks but I'll attribute it to Tony Blair and the Labour Party!

MtG,

quote: We don't. Quality of life in this sense is an objective medical assessment, not a subjective social value assessment. For example, two patients need open heart procedures and pacemakers, but you only have resources to perform one. One patient has a fair probability of living ten or more years longer, and will be able to some extent to move on his own, to get out and do things, etc. The other may live as long, but probably won't, and his only chance of surviving as long as the first patient is with oxygen, and ongoing treatment for other issues, requiring chronic hospitalization or some form of equivalent to chronic inpatient care.

Wouldn't it be fair to allow both sufferers the chance of both living three years - by treating the weaker one - than by introducing disparity and letting one live for ten years and letting the other wither away after just one?

	04-06-2003 02:23									#29
	Support Apolyton, buy Call to Power 2

In the US your insurance rates go up if you receive a poor bill of health, smoke, have heart problems, and myriad of other things. Really sucks if you loose your insurance and have been smoking, sleeping 20 hours a day, and living of bacon double cheese burgers the whole time.

I am lucky, my company will give me FREE life time medical insurance (the same that I am covered on now) for the rest of my life if I work here for at least 10 years. 2 down, 8 to go... then I QUIT!

	04-06-2003 02:59									#30
	Support Apolyton, buy Civilization III: Complete

quote: Originally posted by Japher I am lucky, my company will give me FREE life time medical insurance (the same that I am covered on now) for the rest of my life if I work here for at least 10 years. 2 down, 8 to go... then I QUIT!

Assuming your company doesn't pull an Enron.