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Personal responsibility and health discrimination

By Mirko Bagaric - posted Monday, 17 September 2007


Hospitals and doctors who refuse elective surgery to smokers and obese patients are in urgent need of non-elective attitudinal and ethical reform.

The principal reason used by an increasing number of medicos for refusing treatment to people whose consumption choices contributed to their ailment relates to the notion of personal responsibility. This is the view that people who voluntarily and knowingly engage in conduct that is inherently risky should wear the consequences if the risk eventuates.

The notion of responsibility has an important role in any ethical model. It is pivotal in controlling human behaviour. If the concept of personal accountability was totally removed, people would lose the main pragmatic reason for not engaging in conduct that is destructive to the interests of others and themselves.

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However, the notion of responsibility cannot be invoked beyond its relative importance and allowed to trump more important ideals, otherwise unjust outcomes will inevitably occur.

In the context of medical treatment decisions there are two important principles which make it grossly unfair to factor lifestyle choices into treatment decisions. The most important objective of any moral code is the alleviation of pain and suffering. It is nothing but indecent to stand-by and allow others to endure preventable suffering. Further, the principle of proportionality commands that benefits and burdens should be distributed with regard to, and commensurate with, a person's merit or blame.

This principle most acutely applies in the area of the criminal law and sentencing, where the system attempts to match the harm caused by offence with the pain imposed on the offender.

It also applies in the health sphere. People who smoke and over-indulge at the tuck shop are not engaging in model behaviour, but they are hardly moral monsters. Their flawed conduct is self-regarding - it does not hurt others and in all probability they have a number of redeeming features.

If a moral book-keeping exercise of people is to be undertaken, then the entire person, not just their consumption choices needs to be put in the mix. Many fatties and smokers donate to charities, save stray animals, treat others with concern and respect and allow enough road space to enable drivers to merge.

They too deserve to be treated with concern and respect. Their pain needs to be eased by the best possible medical treatment that is available. They should not be subjected to the puritanical indecent whims of a morally deficient medico.

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To the extent that choices need to be made regarding the rationing of medical services, the only morally acceptable criterion is the likely utility of the patient to the community. That’s why it is better to transplant a heart to a young leading medical researcher than an ageing dog groomer.

However, in an opulent society in Australia where we have virtually infinite medical resources it is rare that choices between patients need to be made.

To the extent that such choices are thrust on the medical system, it is offensive and discriminatory for the health system to have regard to the patient’s contribution to their condition.

Unfortunately, this is one condition that won’t improve by itself. Doctors are not known for their deference and will continue to arrogate to themselves treatment decisions based on the supposed moral character of a patient. The Federal government must immediately pass laws prohibiting health discrimination on the basis of consumption choices.

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About the Author

Mirko Bagaric, BA LLB(Hons) LLM PhD (Monash), is a Croatian born Australian based author and lawyer who writes on law and moral and political philosophy. He is the author of 20 books and over 100 refereed scholarly articles. He is not connected with any political party or other interest group. He is the author of Australian Human Rights Law (forthcoming). Mirko is the author of Being Happy and Dealing with Moral Dilemmas.

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