In order to do this each patient requiring expensive treatment is assessed according to a quality adjusted life years (QALY) score¹. This is an equation that measures all of the aforementioned criteria and is used to assess the cost versus benefit of a particular treatment. If a patients quality of life would improve greatly and the cost of the treatment is low then the QALY score will be high. However, if the benefit to quality of life is high but the treatment is expensive then the score will be low. This tool is useful to a degree in assisting doctors who are trying to decide how to allocate limited resources but it discriminates against certain groups. For instance those patients who are elderly and need a hip operation for example will have a low QALY score because they have fewer quality of life years left to live than somebody in their fifties needing a coronary artery bypass graft (CABG) operation. In this scenario the person needing the bypass operation is likely to be overweight and, or a smoker and could be considered to be responsible for their illness.
[...] who have never smoked and they have twice the risk of developing coronary heart disease (CHD) than non- smokers². There are many other health problems associated with smoking, such as respiratory problems, strokes and other cancers. All of these are unpleasant diseases and treatment or palliation of them could greatly improve quality of life for that patient. However, for many years the risks associated with smoking have been made very public as public health campaigns have become more graphic and hard hitting. [...]
[...] Whilst this is acceptable, there are cases of patients who have no genetic risk factors and the only independent risk factor they have in the presence of coronary heart disease is smoking, thus leaving health professionals with little doubt about its cause5. Therefore, it would be feasible to hold these patients responsible for their disease. This is also true for patients who have a family history of CHD but choose to smoke as they are aware of the risks of smoking in relation to their family history yet they continue to smoke. [...]
[...] Then there is the case of those people with Down's who are considered to have a poor quality of life and are therefore, less deserving of treatment. However, taking all things as being equal then those with Down's have a good quality of life it is just different to others and therefore, not grounds to deny people the chance to carry on living life. I appreciate that once treated people that smoke or are obese are more productive members of society than those with Down's Syndrome, however, if they did not smoke or over indulge this would not be an issue as they would not require treatment and those who were not in anyway responsible for their disease would always get priority. [...]
[...] June (2002); 32- 35. Donaldson, LJ., and Donaldson, RJ. Essential Public Health. Second edition. Petroc Press (2000). Shiu, M. Refusing to treat smokers is unethical and a dangerous precedent. British Medical Journal. April (1993); 306: 1048- 1049. Ubel, PA. Transplantation in alcoholics: Separating prognosis and responsibility from social biases. Liver Transplantation and Surgery. May (1997); 343- 346. Higgs, R. Human frailty should not be penalized. British Medical Journal. April (1993); 306: 1049- 1050. Emberson, JR., Whincup, PH., Morris, RW., and Walker, M. [...]
[...] However, put aside the need of other patients and now concentrate on the issue of giving an organ to a patient who has created their own health problems. In the case of smokers, they often receive transplants and operations without having to abstain from smoking although some doctors ask them to try to give up after the operation once the treatment is complete; they are free to carry on with the behavior that necessitated the treatment in the first instance. [...]
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