Some examples of Self Inflicted Diseases:
- Skin cancer following prolonged exposure to sun rays
- Obesity following bad dietary habits
- Lung Cancer due to smoking
- Liver Cirrhosis following excessive drinking
- Heart disease and hypertension following an unhealthy lifestyle
- HIV following conscious high risk taking behaviour
We must consider three principles when answering this question:
- Autonomy – there is an argument that we should be free to choose our activities and not and not be penalised as a result of them as long as they are not harming others. It could be argued that since some harmful activities such as smoking are addictive, and we understand the underlying neurobiological mechanism by which this occurs. There is less ‘fault’ than we think and some people may be more of a victim of genetics than their own behaviour
- Justice – we should optimise the use of our resources and make the most efficient use of precious funds
- Beneficence – this principle implies a duty to treat all sufferers of a disease, regardless of the cause.
To many, it seems fair that those who take risks should accept their consequences.In a system where resources are scarce, it is important to prioritise how budgets need to be allocated. Public perception of the health service may be worsened if they see people who are less deserving in their eyes receive treatment when they themselves are struggling to be treated. It is also true that patients with self inflicted diseases often relapse. They may feel that they have gotten away with it before and return to their high risk behaviours. Treating them might therefore only be a temporary measure for a problem which may recur later on, e.g alcohol relapse following liver transplant. As well as this allowing treatment of self inflicted diseases may remove individual responsibility for one’s health. People will not consider some behaviour as high risk in the first place because they know that they will receive treatment if they need to. In some cases ( such as drug – related conditions), treating patients may actually be seen as encouraging illegal activities.
However it can be argued that the large majority of diseases are self inflicted to some extent, even though the link may not be obvious. Indeed, bar a small number of genetically inherited diseases, most are linked in one way or another to our lifestyle. Excluding self – inflicted conditions would restrict a health system to treating only a minority of conditions. Public perception would be greatly damaged if we could not get help for some of the most common diseases
Assuming that we may want to exclude some self – inflicted diseases from NHS care, it would be difficult to determine the extent to which a disease is self – inflicted and therefore whether it should be treated or not. Where do we draw the line?
Example: A woman has unprotected sex with her long – term husband because she trusted him, but where the husband acquired HIV through a one – night stand and refused to notify his wife. Would you say that the wife’s HIV was self – inflicted? How would you know she is not lying simply to get treatment?
On public health grounds, it is necessary to treat any transmissible diseases, to control them and to prevent onward transmission.
It is also important to note that some self – infliction (such as excessive drinking or smoking) may reveal underlying issues (e.g psychiatric conditions or psychological ill – being) that may need to be identified and treated. Not allowing patients to visit a doctor for self inflicted illness may prevent the treatment of those underlying causes.
We are in a free society where individual choice is of crucial importance. The NHS should complement this society choice an not work against it
Ultimately, it is down to society to decide how it wants to use its own health system. Based on the arguments above, it would be very difficult to separate with certainty self – inflicted from non self – inflicted diseases and therefore such an exclusion system would not be fair or practical.