Is it ethical?

[Bini]

Is it ethical for doctors to refuse treatment to or operating on patients living unhealthy lifestyles?

"Unhealthy" specifically being defined by some articles as, smoking and obesity, but may extend to others. I did not add any links since a quick search online will pull up numerous discussions on the issue, some of which make mention of surgeons/organisations that openly oppose treating and operating on patients living unhealthy lifestyles. Here are a couple other considerations that I thought about. Is it ethical for doctors to refuse treatment to unhealthy patients and yet continue to treat athletes that typically endure repeated injuries throughout their career or hobby? What about in areas that have a publicly funded healthcare system, is it ethical to refuse treatment to unhealthy patients that contribute to this? What are your thoughts in general or addressing each point individually?

[applepansy]

IMHO, Its unethical to refuse to treat unhealthy people. Good Grief! Who are they going to treat if they aren't going to treat people with health issues. Obesity is a disease. Science is finally starting to catch up with that statement. I agree that sometimes people overeat for emotional reasons but once they reach Obesity they are sick....regardless of how they got there.

On to people who chose to smoke.... given enough time they will eventually develop a disease related to smoking. Just because they smoke shouldn't mean we refuse medical treatment.

For me it comes down to one simple thing: We should do what Christ would have us do.

John 13:34

A new commandment I give unto you, That ye love one another; as I have loved you, that ye also love one another.

I don't see how we can "love one another" if we're refusing medical treatment because we "think" a person made themselves sick.

[RMGuy]

As a doctor in our medical school recently described this to me.

A good doctor is like a pilot to a ships captain. It is not the pilots ship, it is not their course to steer. It is their job to provide advice, assistance, and help as needed and as requested. If the patient decides to run their ship full speed into the rocks, then it is their ship. A good pilot will be standing beside the captain until the ship sinks, offering advice and assistance along the way, but never insisting or withholding help.

-RM

[Blackmarch]

Is it ethical for doctors to refuse treatment to or operating on patients living unhealthy lifestyles?

"Unhealthy" specifically being defined by some articles as, smoking and obesity, but may extend to others. I did not add any links since a quick search online will pull up numerous discussions on the issue, some of which make mention of surgeons/organisations that openly oppose treating and operating on patients living unhealthy lifestyles. Here are a couple other considerations that I thought about. Is it ethical for doctors to refuse treatment to unhealthy patients and yet continue to treat athletes that typically endure repeated injuries throughout their career or hobby? What about in areas that have a publicly funded healthcare system, is it ethical to refuse treatment to unhealthy patients that contribute to this? What are your thoughts in general or addressing each point individually?

depends.

I'd say for first timers or for those whocan pay all the costs that go along with their lifestyles that no it wouldn't be ethical.

If the patient can't pay, or refuses to change their lifestyle after having been instructed by the doctor, then there is quite a bit more leeway.

[marshac]

I know of patients that are "fired" by their doctor- my father-in-law has crazy hypertension and was "fired" for being non-compliant with his BP meds. I can't say I blame the cardio doc- you're a scarce resource that people are waiting in line to see, so why waste time "treating" people who obviously don't care that they're going to have a stoke and die? Additionally, if you're still their doctor, they might try and sue you for some lame reason.

Personally, an experience this past Saturday made me think about how to gracefully turn patients away- while at a hardware store, a family of four rather large individuals walked down the aisle I was in and began looking at products- the smell was overwhelming and clearly one or more of the family members wasn't adequately cleaning the entirety of their skin. I had to leave the aisle (as did everyone else) even though I wasn't finished because I was becoming nauseated and quite literally about to lose my lunch... it then occurred to me... what if this same family walked into my office? How does one say "please shower and then come back?" without seriously offending them?

As far as socialized medicine- it's not the physician's place to determine social policy on who should receive treatment or not. While it's true a smoker will cost more over the long term, society will have to decide how to attribute these additional costs to that risk group (like a tobacco/alcohol tax).

[Guest]

It goes against the Hippocratic Oath to turn a sick patient away just by virtue of their being sick or any political/personal bias. Here's the part of the Oath that applies:

"I will remember that I remain a member of society with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm."

(bold mine)

But, if a patient was diagnosed by the doctor and then prescribed certain procedures to follow to get them on the path to health and the patient refuses to follow the treatment plan, then it is not against the Oath to refuse further treatment until such a time that the patient performs their part of the relationship.

It also does not go against the Oath to prescribe only treatment that aligns with the doctor's moral code, so if, for instance, the doctor is Catholic, he may refuse to prescribe birth control pills as a means to prevent pregnancy but he will need to offer an alternative option.

Edited April 12, 2012 by anatess

[HEthePrimate]

depends.

I'd say for first timers or for those whocan pay all the costs that go along with their lifestyles that no it wouldn't be ethical.

If the patient can't pay, or refuses to change their lifestyle after having been instructed by the doctor, then there is quite a bit more leeway.

Ah yes, "money answereth all things." So, in your opinion it's unethical to refuse treatment to someone who can pay, but ethical to refuse treatment to someone who can't? This kind of attitude explains a lot about our society.

[FunkyTown]

I have to admit that I'm a bit non-plussed at the idea of not treating someone because they're poor. Can you clarify what you mean?

I'm about to leap in to a tirade about how I agree with you entirely, which is why I left a guy bleeding in an alley after he was mugged because he couldn't pay me for my kindness.

I will be saying I agree with you, but I really don't. However, before I leap in to my boffo counterpoint, can you clarify what you mean? I want to make sure my moral outrage is justified.

[Gwen]

Ethical or not it happens all the time.

Insurance companies raise rates on ppl that have "pre-existing conditions" or unhealthy lifestyles. They can still get treatment but they have to pay for their choices.

When my mom discovered she had thyroid cancer she also discovered she was pregnant. She was turned away by many doctors that refused to treat her unless she would have an abortion. She (after a lot of prayer) refused the abortion and had to go from dr to dr until she found one that would treat her. It is probably why she is alive today, the other doctors probably would not have gone to the lengths that this dr did to save her life.

I had to switch neurologist for my son who has epilepsy. He has issues with the medications and the dr refused to believe me that they were there. It was atypical and he didn't like dealing with the fact that it wasn't going to be straight forward in treatment. He became very cold and hostile toward me and then outright said if I wasn't going to do as he said then he was done with me. Now we see a new dr.

[MarginOfError]

I might be publishing something about this topic soon, so I won't share the details because of copyright. But we're pretty sure the paper will be controversial.

While it seems like it should be an easy question to answer, it isn't really.

Should someone with advanced lung cancer get high priority on a transplant list if he continues to smoke?

Just recently, there was a liver cancer recipient who had gotten himself moved up the list by doing all the lifestyle changes expected of transplant candidates. Within weeks of receiving his new liver, he was had gone back to heavy drinking. There isn't much we can do about a case like this, but when the typical lifespan of a transplant is 15-20 years, engaging in risky behavior can reduce that by up to half. Is it ethical to use these resources on people who will choose to waste it?

Those are examples in transplants. What about in less extreme measures? A cardiac patient chooses antihypertensives over lifestyle change. What that really means is that the patient chooses to extend the length of his life at the current quality of life. But, he's on antihypertensives--his quality of life is less than ideal already. Is it ethical to chronically treat people so that they can maintain a substandard quality of life? Or is it better to withhold some treatment so that they will change lifestyle, thus improving length of life and quality of life.

These are big debates without clear answers, and a lot of it will be circumstantial to every disease and/or treatment.

[Gwen]

I wanted to make a comment (though I don't know how it is meant by others) on the "those who can pay" for the lifestyle vs "those that can not pay". I do see the issue with attacking the poor. However, I do agree with it to an extent.

For example, if I have a good job, pay extra insurance premiums due the fact that I smoke (and it's worth the trade off for me) and when I have lung issues I see the dr and pay for all my medical bills myself. Under that circumstance I can afford my lifestyle. Maybe I can't afford any of it and I live in poverty and choose to die of lung cancer never asking for a dime from others .... well I made a choice on my lifestyle.

On the other hand you also have ppl that refuse to work, choose to smoke and then ask the government to pay the thousands extra in health bills just because "I'm poor". I have a problem with that. If you are asking me to pay your bills then I should have a say in how you live. That is the trade off you make by choosing to not be self sufficient. You give that freedom away. Don't cry to me that I took your freedom to kill yourself slowly when you ask me to pay the bill.

This can be applied to many things. For example I have 5 children. By today's standards that is a lot. We pay for every one of them. No one helps us. My husband works hard and we make choices and sacrifices in lifestyle to have those children. If someone came along and tried to require that I have my tubes tied (or some other form of bc outside of my personal choice) I would be livid. Who are you to tell me I can no longer have children?

However, I know a young woman who is under 18 and has 2 children. The government pays all her bills. They pay for the kids, the food, the housing, the medical bills, etc. She is on total government support. I know her very well and spent over 17 hrs with her at the birth of her second child. I love her and do all I can to help her learn who she is and change her lifestyle. In the same breath I think the government should say, "If we are paying the bill you will have an iud (or something else that does not require dependence on her for effectiveness) put in before you leave the hospital." I think teen (or even single) mothers depending on the government should not be allowed to get the money without a dr's note saying they are preventing pregnancy. If they want to have more children then they need to become self sufficient and support them. I'm not talking about ppl that need a little help or for a short time but the folks who are on total government support and show no interest in getting a job.

From that perspective I agree, if you can afford you lifestyle go for it, if not expect someone to tell you how to live or get cut off.

[Blackmarch]

Ah yes, "money answereth all things." So, in your opinion it's unethical to refuse treatment to someone who can pay, but ethical to refuse treatment to someone who can't? This kind of attitude explains a lot about our society.

After their first treatment or if they do not heed the doctor's instructions, then yes . that is just. now if you mean that ethical = a christian level of morality and conduct, then it probably won't quite cut it, now if you want use that (christian morality) for the line to define ethics how are you going to get the necessary resources to treat folks resources without getting paid? unless we go to an acceptible socialistic structure where we all hold hands, sing kumbyya, and all parties are willing to sacrfice their gains, then yes what is ethical is not going to be the same level as what is a christian moral level.

Its just as ethical to refuse on grounds of not willing or able to pay, as it is to sell an item, good or service.

If you were a doctor adn you had someone who was not able to pay, are you willing to spend out of your own pocket to cover them if no one else is willing to do so?

Edited April 12, 2012 by Blackmarch