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Rationing elective surgery for smokers and obese patients: responsibility or prognosis?

Published on Dec 1, 2018in BMC Medical Ethics2.507
· DOI :10.1186/s12910-018-0272-7
Virimchi Pillutla1
Estimated H-index: 1
(Monash University, Clayton campus),
Hannah Maslen9
Estimated H-index: 9
(University of Oxford),
Julian Savulescu47
Estimated H-index: 47
(University of Oxford)
Abstract
In the United Kingdom (UK), a number of National Health Service (NHS) Clinical Commissioning Groups (CCG) have proposed controversial measures to restrict elective surgery for patients who either smoke or are obese. Whilst the nature of these measures varies between NHS authorities, typically, patients above a certain Body Mass Index (BMI) and smokers are required to lose weight and quit smoking prior to being considered eligible for elective surgery. Patients will be supported and monitored throughout this mandatory period to ensure their clinical needs are appropriately met. Controversy regarding such measures has primarily centred on the perceived unfairness of targeting certain health states and lifestyle choices to save public money. Concerns have also been raised in response to rhetoric from certain NHS authorities, which may be taken to imply that such measures punitively hold people responsible for behaviours affecting their health states, or simply for being in a particular health state. In this paper, we examine the various elective surgery rationing measures presented by NHS authorities. We argue that, where obesity and smoking have significant implications for elective surgical outcomes, bearing on effectiveness, the rationing of this surgery can be justified on prognostic grounds. It is permissible to aim to maximise the benefit provided by limited resources, especially for interventions that are not urgently required. However, we identify gaps in the empirical evidence needed to conclusively demonstrate these prognostic grounds, particularly for obese patients. Furthermore, we argue that appeals to personal responsibility, both in the prospective and retrospective sense, are insufficient in justifying this particular policy. Given the strength of an alternative justification grounded in clinical effectiveness, rhetoric from NHS authorities should avoid explicit statements, which suggest that personal responsibility is the key justificatory basis of proposed rationing measures.
  • References (22)
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16 CitationsSource
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Background Since 2000 various tobacco control measures have been implemented in the UK. Changes in the smoking status of low and high socioeconomic status (SES) groups in England during this period (2001–08) are explored. Methods Secondary analysis of the Health Survey for England general population samples was undertaken. Over 88 000 adults, age 16 or over, living in England were included. Smoking status (current, ex or never) was reported. SES was assessed through a count of seven possible ind...
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Background Estimates of the economic cost of risk factors for chronic disease to the NHS provide evidence for prioritization of resources for prevention and public health. Previous comparable estimates of the economic costs of poor diet, physical inactivity, smoking, alcohol and overweight/obesity were based on economic data from 1992–93. Methods Diseases associated with poor diet, physical inactivity, smoking, alcohol and overweight/obesity were identified. Risk factor-specific population attri...
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Objective:We sought to examine the effect of body mass index (BMI) on 30-day morbidity and mortality in a large cohort of patients undergoing nonbariatric general surgery.Summary Background Data:Obesity has long been considered a risk factor for poor outcomes from a variety of surgical procedures, y
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#1William J. Rubenstein (UCSF: University of California, San Francisco)H-Index: 2
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Allocating health care resources based on personal responsibility is a prominent and controversial idea. This article assesses the plausibility of such measures through the lens of luck egalitarian...
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