Should the NHS treat Obese patients or smokers

RGN1 · Jun 11, 2007

You know this is going to be a VERY controversial subject now don't you?:)

I think that the NHS should help to support those who are trying to change their lifestyles etc and I think that they have a big a part to play in health promotion and so on.

It does become difficult when you start to talk about withdrawing treatment though. I think that if there is a real danger to the patient if you operated on them, either because they are dangerously obese or their breathing is seriously compromised then the doctors do have a right to not treat at that time - as they would if a urology patient had a UTI on the day of surgery where that could compromise the surgical outcome. In both circumstances it would be fair to delay surgery until the patient was in a better condition to undergo the procedure.

However, not all obese people are going to have problems with anaesthesia & not all smokers are either, so I think it has to be on a case by case basis rather than as a blanket thing. I think the doctors should be able to decide not to operate only if doing so could be as serious a threat to the health of the patient as the condition that is threatening them in the first place

I have met patients who are seriously compromised by their lifestyle. choices and have no intention of changing & in those cases I do tend to feel that they've made their bed let them lie on it!! However, I don't think that in truth it can be my decision I think you have to do the best for people that you can and do the best you can in trying to get the health message across.

Years back, when I worked in a private hospital in the OPD, we had a vascular surgeon who would not operate on his private patients if they smoked or were obese. they would have to either lose some weight or give up smoking before he would do the surgery. It wasn't a problem because as a private doctor it was his decision but what really made me laugh was that as soon as the clinic had finished & the patients gone he would put his feet up on the desk & light up a cigarette!!!!

Silverdragon102, BSN · Jun 11, 2007

Yes I do think the NHS should treat smokers or obesity patients. Currently there isn't enough support to help patients address these issues especially obesity. Aids should be available to help people address lifestyles and the changes and I think also you have to look at the community as a general and whether it is a deprived area as that will have an impact on lifestyle. Sometimes it is a catch 22 as someone is overweight and needs some sort of replacement ie knee but can't loose the weight because they can't get any exercise and just because they are overweight does not mean that they are not eating properly. Yes there are some that have no intention on addressing their lifestyle and then there are others that do address but can't always manage it without support to which there is little or no support. Telling someone to eat less does not always work and gives no motivation. I am obese although BMI has gone down from 48 to 30, paid for gastric bypass myself as I wanted to loose the weight and couldn't loose through dieting (believe me I have tried everything and finally stopped dieting but eating healthy and didn't go OTT) and have hardly claimed anything on the NHS and always worked, I would not like to think I am being penalised because I am overweight when I have always paid into the system.

Just my opinion

allnurses Guide · Jun 11, 2007

Hi All....I have a discussion group coming up and one our subjects is:
Should obese adults or individuals who smoke have healthcare withdrawn until they redress their lifestyle choice?
I have lots of my own opinions and have researched this thoroughly on the net, I just thought I would post it on here and see what others thoughts were, as in britain they're so many initiatives and programs in place for healthier lifestyles etc, but if people dont start taking these on board is it acceptable to expect the NHS to pick up the bill?
Anyway, hope u guys have some good opinions about this.

Ohh now that's a tricky one and where do you draw the line. just as obese adults and smokers make health choices you could say the same for sports injuries, motorcyclists or any motorist for that matter these are all lifestyle choices. As a person who participates in what some would classify extreme sports and a motorcyclist I would say no, but then again is it fair for me to expect the NHS to pay for my lifestyle, I don't know.

There are many treatments that are with held, for example I run pre-assessment and within the last month I have deferred at least 6 patients because of thier weight as the surgery is higher risk with a higher BMI. I give smoking cessation advise and if the chest is too problematic then would again defer, but these are because of clinical issues.

But should all healthcare be withdrawn, the NHS is free at the point of delivery, that is the philosophy and that is the aim and unless this changes then I don't see how it is fair to discriminate because of lifestyle choices.

cariad · Jun 11, 2007

my opinion is that where do we draw the line?

what do we do with the overdoses and people who cut their wrists deliberately are brought into ER for treatment as they have either changed their minds or been found unconcious.

they are in ER because they have abused their bodies exactly as someone who has put too much alcohol, food or cigarette smoke into their bodies.

what about anorexia?

do you refuse them treatment because they are deliberately starving themselves.

why are your questions only about obesity and smoking?

PixieThunder · Jun 11, 2007

I know its very controversial subject, and I am glad that it is bringing lots of debate and good answers as I had hoped. I read in a sunday 'rag' newspaper that the NHS is going to force patients to slim down before being allowed routine operations and will base treatment on their BMI. I dont know how true or how reliable their source is, or even if such a newspaper should ever be taken as the truth, but it does raise interesting points.

As previous replies have said, I agree that not everyone should be judged in the same way, and that each individual should be on a case by case scenerio. However, individuals should be given advice before operations are undertaken, and if they are not intent on changing their lifestyle and making the more healthier choices in life then maybe they shouldn't be given priority on things, but not discounted altogether. I have so many views on this its sooo hard to get them all down!

PixieThunder · Jun 11, 2007

why are your questions only about obesity and smoking?

It's just cos thats the subject matters I was given, others potential student were given other topics and its just to spark debate. It is not a witch hunt against Obese individuals or smokers.

CT Pixie, BSN, RN · Jun 11, 2007

Lifestyle choices that affect people are not just limited to smokers and obese people. What about those who don't eat according to the Dietary recommendations they might not be obese but their lifestyle choices on what to eat are seriously affecting their health (high fat, high calorie etc), drug addicts, alcholics, people in abusive relationships who don't leave who sustain injuries from a betting and having to get medical treatment for injuries, people who have dangerous hobbies, non complient diabetics, etc. It would be hard if not difficult to just limit witholding of NHS from just obese and smokers. There are a zillion lifestyle choices that affect a persons health and well-being, its not just limited to smokers and obese.

Oh lets not forget, those who choose not to wear a seatbelt and have an accident..that was a choice, which is very detremental to health and well being. Or how about someone who is breaking the law and gets hurt doing it..

As the others have said, how and where do you draw the line.

madwife2002, BSN, RN · Jun 11, 2007

This subject always brings heated debate. I would always worry that if we start decided who we treat and who we dont treat because of smoking or obesity then where do we draw the line. Each and everyone of us has some habit which can be detrimental to health. If we start dictacting that people who smoke are not entitled to health care then we could be in the new position of a new form of discrimination, because there would always be somebody who would take on the NHS sue and win.

I dont believe we should pick and choose who we treat! Years ago in the NHS and it may still go on, when somebody was on the transplant list the ones who were young, male and had a family were placed higher on the list than those who were single. It was deemed the married men had more to live for, as they had to provide for a wife and kids!!! So if we disect further into peoples lives where would we stop, oh if your white you can this type of surgery but if your black well no sorry you cant have it! Or would we review somebodies sexuality and say mmm well your hetrosexual so you should always be top of the list. Ah well you seem like a nice person so you can have better care than the shy, quieter person. NO we cant allow it to happen because it would be never ending. As the money decreased further in the NHS there would be more and more segregation and there would be the haves and the haves not!

madwife2002, BSN, RN · Jun 11, 2007

Or how about well it runs in your family so tough

english_nurse · Jun 12, 2007

the ethos of the nhs is 'free care for all at the point of delivery'

its a slippery slope to go down for example...

you took that overdose on purpose, sorry we wont treat you

you drove your car dangerouly and crash, sorry we cant treat you

you drank 15 litres of cider, ervery day for five years, sorry we wont treat you

you are fat, you got diabetes, sorry we wont treat you...

if you refuse surgery to smokers/ obese people do you refuse to treat other related conditions too??? for example high blood pressure.

If it comes down to finance, we should be looking at where the money is wasted and the strain that government targets put on hospitals, and possibly look into a system where if you present at A&E you should be able to prove you are entitled to free treatment in this country and are not here illegally........ im sure i will be burnt at the stake for that one but this issue creates a huge strain on the nhs

there is also the tax issue, smokers pay alot to the treasury why shouldnt they be treated????????

english_nurse · Jun 12, 2007

PS

Im obese, my husband smokes, if it becomes policy we are screwed lol arggghhh!!!!!!!!!!!!!!!