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Thread: The NHS; should we draw a line?

  1. #1
    Magnificent Moderator Kaitey (:'s Avatar
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    Default The NHS; should we draw a line?

    This is a topic that's interested me for a while but before I dive on in, I want to make some things abundantly clear;

    1. I think the NHS is amazing and I'm genuinely hugely grateful for it's very existence. This is not a thread to bash the NHS.
    2. I'm not trying to start any personal arguments so can we please keep to the subject matter and try and take the points raised objectively and not as personal attacks should they differ from our own opinions.
    3. I'm not trying to make anyone feel ganged up on or like I'm picking on something they've said, it's just a topic that got me thinking.

    I've seen/heard a lot lately about how things like fixing stretched lobes gone wrong shouldn't be treated by the NHS (IRL, on here, on facebook etc) and have seen a lot of different reasons for it, but one I've heard a fair few times is because the person was daft and did it to themselves they shouldn't be expecting the NHS to foot the bill.
    This got me wondering; if the NHS was to agree with this and decide to go down this route, where would it be appropriate for them to draw the line? Should they treat alcoholics for conditions stemming from their addiction (and how would it be determined? Liver issues may be genetic or something like a broken bone may have happened because they had been drinking etc)? Should obese people get free treatment for obesity related issues etc? Should there be a "grace period" where there is X amount of free treatment/support provided but if they don't make the effort to change their circumstances this is revoked? i.e. if after 6 months of support the obese patient hasn't lost any weight should they no longer receive the same level of support free of charge?

    I'm mostly interested in the idea of 'patients who could help themselves but aren't' line of thought but figured I'd mention the lobes repair thing since it was what sparked my interest!
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  2. #2
    Senior Member Jester's Avatar
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    I'm wondering if perhaps morbidity levels are a factor? As in, having bust up ear lobes won't kill you, but having liver issues (even if they are stemming from alcohol abuse) will. I suppose some people also believe that addicts can't help themselves, while, using the stretched lobes example, that was absolutely a choice, where alcoholism is not. (I know it's not as clear cut as that, but generally speaking.)
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    Awesome Admin Hazel's Avatar
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    I don't think you can compare someone who is ill to someone with stretched lobes.

    The difference here is simple - is there a health issue. So the only case where someone could/should get their modification repaired on the NHS is if they can prove beyond a doubt that it is having some kind of significant impact on their mental health and quality of life. Otherwise no it's not a comparision.

    Eating disorders resulting in being over or underweight/obese are the result of a MH problem most of the time as is any kind of addiction such as drugs or alcohol. They are often the result of living in poor conditions or poverty so to cut the line there would be to refuse help to those that need it the most and probably result in more death and suicide/suicide attempts.

    You could go even more extreme, what about someone who rides a motorcycle - should they get less treatment because being in a car is safer? Or someone who runs or plays a sport and incurs a sports injury - should they not be treated because they didn't have to do sports etc...

    I think the line is good where it is, someone with a scar from a mod or stretched lobes should foot the bill themselves, as should someone who wants a breast reduction that's having no impact on their physical or mental health, someone who is overweight with no severe physical or mental health issues should simply be encouraged how to eat better/less and move more not be given tablets etc

    At the end of the day you can try and attribute "blame" for nearly everything, poor diet, not reducing stress, being over/under active, mixing with the wrong people, trying the wrong things etc at which point we wouldn't be treating anyone for anything other than what could be proved to be 100% unrelated to lifestyle/choice which is impossible.
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  4. #4
    Magnificent Moderator Kaitey (:'s Avatar
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    Quote Originally Posted by Jester View Post
    I'm wondering if perhaps morbidity levels are a factor? As in, having bust up ear lobes won't kill you, but having liver issues (even if they are stemming from alcohol abuse) will. I suppose some people also believe that addicts can't help themselves, while, using the stretched lobes example, that was absolutely a choice, where alcoholism is not. (I know it's not as clear cut as that, but generally speaking.)
    That's true, you'd also then be forced to try and prove whether things were/not an addiction like whether someone was obese because they were addicted to food or because they had no reason/motivation to get/be healthier etc, I'd wager you would then have people claiming a variety of things stemmed from addictions and that they were addicted to stretching etc.
    And also if other MH issues would factor in, like if patient A is a type one diabetic and struggles to maintain their sugar levels as they struggle to eat well/enough or struggle to have the motivation to actually test and medicate themselves but patient B refuses to alter their diet / medication as needed, is patient A more entitled to help than patient B?

    (I personally think if we started "drawing lines" things could very quickly spiral out of control, but I have an awful feeling such things may well be suggested at some point by the current/future government)
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    Senior Member julian's Avatar
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    I think the problem is that you could never get everyone to agree on the boundaries. For example, someone rides a cycle off-road and falls off breaking a leg. Do you treat them as they are trying to keep fit, or not as they are pursuing a (slightly) dangerous sport?

    One of the problems is that the original idea of the NHS was that over time, it wouldn't be needed so much as the health of the nation improved. What hadn't been appreciated was the huge increase in possible treatments available since the founding in 1948 (for example transplants), and the costs involved.

    If doctors are correct about the ending of antibiotics, it is likely that in 10-30 years time much of modern medicine won't even be possible anyway, with death rates during surgery etc returning to 1930 levels.

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    Senior Member Firedrake's Avatar
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    I'd say you'd have to go case by case, we have a different system here where anyone who can prove they're an Australian citizen in a public hospital has all their treatment covered by Medicare, if you choose to you can go to a private hospital but nothing is covered.
    We also have reciprocal agreements that are supposed to cover "neccessary treatment" if it can't wait until they go back home, but it's hard to determine what is "neccessary" in the case of something that may not seem a big deal to us, could be something huge to them. Like people coming into the emergency dept for colds etc. the cold symptoms may also be caused by other things that may be more serious so we can't just turn them away because it's minor
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    I personally don't think ANY self-inflicted injury should be treated on the NHS. I think it's appalling that I (21 year old broke student) can't get a ganglion (painful swelling resulting from tendon damage that is no fault of my own) treated on the NHS, while people who have, for example, drunk themselves into liver failure, get free treatment on the NHS.

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    Awesome Admin Hazel's Avatar
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    Quote Originally Posted by Walroz View Post
    I personally don't think ANY self-inflicted injury should be treated on the NHS. I think it's appalling that I (21 year old broke student) can't get a ganglion (painful swelling resulting from tendon damage that is no fault of my own) treated on the NHS, while people who have, for example, drunk themselves into liver failure, get free treatment on the NHS.
    Seriously? That would also be impossible to regulate. There would also be an insane amount of deaths of people with mental health issues and those who may have had a lower level of education or upbringing, not to mention people who can't afford to look after themselves. All of those groups of people could be seen to be causing their own poor health.
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  9. #9
    Senior Member Jester's Avatar
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    So, if someone isn't taking the correct precautions using a power tool and seriously hurts themselves, they should be allowed to die? Say it isn't a fatal injury, they should just not be treated, which could result in further complications, which could result in more serious problems that NHS will have to deal with (e.g., infections, septicimia, even something like gangrene; perhaps extreme examples, but all possible)?

    What about people who ride bicycles without wearing a helmet? Is that head injury then self inflicted for not protecting themselves?
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  10. #10
    Awesome Admin Hazel's Avatar
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    Quote Originally Posted by Jester View Post
    So, if someone isn't taking the correct precautions using a power tool and seriously hurts themselves, they should be allowed to die? Say it isn't a fatal injury, they should just not be treated, which could result in further complications, which could result in more serious problems that NHS will have to deal with (e.g., infections, septicimia, even something like gangrene; perhaps extreme examples, but all possible)?

    What about people who ride bicycles without wearing a helmet? Is that head injury then self inflicted for not protecting themselves?
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