Tuesday, 30 May 2023

Rights and Responsibilites Part 1: Healthcare

We hear so much about “rights” in the media.  Somebody fighting for some basic “rights”, debates about personal “rights”.  But we hear so little about “responsibilities”.  When you apply for jobs, or get a bill, or get statements about accounts, you see a section called “Rights and Responsibilities”.  That is because the two go hand-in-hand. Yet, it seems that most people don’t think about “responsibilities” when they think about “rights”.

Most people can’t even differentiate because rights and privileges.  That is because there really is no such thing as privilege anymore.  Anything seen as a privilege is instantly shot down in this politically correct world. So, everything has become a “right”.

With that in mind, let’s just look at some of these “rights”.  We all have rights to healthcare.  Fair enough.  But, how much of it is a right?  Some would argue that all healthcare is a “right” and that no one should be turned down for anything just because of lack of funds.  That is a noble stand.  I agree that it is a shame to withhold medical treatment for purely financial reasons.  But, is there enough funding to continue with that stand?  Residents are entitled to free NHS care “because they pay their taxes” is an argument for free healthcare.  But, what about those who have never paid taxes?  Surely, they are not excluded?  Don’t they have a “right” to free healthcare?  And how far can we take treatment?  Is it a “right” for anyone and everyone to get life-extending treatment even when it is futile and costly?  These are ethical questions that then become legal battles.

On the flip side, what about responsibilities?  If you have a “right” to free health care, shouldn’t there be accompanying responsibilities to ensure that you maintain your health?  Such as following instructions by your doctor to take medications, follow treatment plans and follow-ups, and proper diet and exercise.  There is flagrant abuse of the system when people destroy themselves and then expect the healthcare system to fix everything. 

Case in point (an extreme case): recently, a young man was hospitalised for acute liver failure after a binge-drinking session.  While in hospital, he walks out and enters a pub across the street, attempting to order alcohol.  He was not served alcohol and authorities were alerted and he was taken back to hospital.  His father is understandably upset by the incident, and furthermore, as a good father, he is fighting to overturn a recommendation that liver transplant patients must abstain from alcohol for at least 6 months before getting a transplant.  This young man’s life is in acute danger.  Doctors have given him 2 weeks.  Therefore, he would be dead before he can get a transplant.  He is a binge-drinker, not a chronic drinker, and he may have been suffering some confusion related to the acute liver failure.  Or, he may have some psychiatric disturbance.  Either way, he has no idea why he left the hospital and attempted to get alcohol.  I feel for the father.  It is obvious he is concerned enough to fight for his son to get a liver transplant to save his life.  But, does he have a “right” to this transplant?  The number of liver donors is low; With alcoholism being a serious problem in the UK, that number becomes even lower.  Is it right to give a transplant to someone who may not be able to live up to his responsibilities to protect that transplant?

Of course, the answer to this case is not to make it available only to those who can afford it.  That would only lead to black market transplants.  But, the reason that recommendations are in place is to ensure that those who receive these scarce but life-saving measures are the best candidates. Too many people die waiting for transplants as it is.

Another case in point: An American woman has been granted a rich payout from a tobacco company, on behalf of her mother, who died from longterm tobacco use.  Or, in other words, tobacco abuse.  Of course, the argument was that the tobacco company was liable for the effects of tobacco and fraudulent in its advertising.  Though I would never defend the tobacco industry, is it right that they should pay out to survivors of those who smoked?  The health effects of smoking and tobacco have been highlighted for so long now, that those who really wanted to quit, could have sought help.  Smoking is addictive and it may be very difficult to quit.  Furthermore, lung damage from smoking takes years to reverse, if at all.  So, tobacco companies may be liable for some of the problems, but $13-million worth? 

Some people assert their right to smoke, or their right to decline medical treatment, or their right to make poor choices.  Where is the responsibility in that?  Then, when they run into trouble, they expect that medical treatment will put them right again?

Despite what one believes about fundamental rights to healthcare, it should be acknowledged that many specialists practice outside of the NHS and receive higher pay from private insurance and individuals.  This is an attractive option for many specialists who are at the top of their field, so is access to medical care really equal for all?  Should it be?

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