Ill Judged: The faulty logic of judging the sick.

"That'll be £10 pplease. You're ill because of your bad choice in furniture."

“That’ll be £10 please. You’re ill because of your bad choice in furniture.”

The greatest griefs are those we cause ourselves – Sophocles

                 I’m sure Sophocles thought he was being quite clever when he said the quote above. It’s one of those sayings (like most sayings touted on Facebook under a picture of a heroically sad cat) that sound like they should mean something but don’t.  The worst things that happen to us are the things we do to ourselves. This isn’t necessarily true. If an imaginary gentleman called Fred stabs me in the toe without provocation, then I think I can fairly correctly blame Fred for causing a major grief in my life. Bastard, no wonder he’s imaginary. The quote is especially surprising given that it comes from Sophocles, a man who wrote several plays about Oedipus. Oedipus accidentally killed his own father and married his own mother. When he eventually found out the truth, he wisely dispensed with appearing on Jeremy Kyle and blinded himself. Subsequently Oedipus’ family were said to be doomed for three generations. In conclusion we have three generations of people with terrible things happening to them that weren’t their fault. Good work Sophocles.  Sophocles wrote several tragedies where awful things were generally fated to happen to people. Fated. In that the people involved couldn’t help it. Perhaps Sophocles would have been better off saying, “the greatest griefs are those caused by uncontrollable forces of nature and destiny.”

Katie Hopkins probably thought she was being quite clever when she decided she knew how to fix the National Health Service.  Katie Hopkins proposes that those who eat, drink and smoke too much should pay more towards any additional NHS care they require. The delightful Katie then goes on to state, “Frankly if you don’t care about your body or your health, then as a taxpayer funding the NHS, nor do I.” Katie Hopkins must be a very wise individual, with years of research into healthcare, economics and politics to come to this conclusion. A cursory glance reveals that in fact Katie Hopkins is a former and repeated reality TV contestant. (The Apprentice, that celebrity in the jungle one and nearly Big Brother if you must know). To be completely fair she did study Politics and Economics at the University of Exeter. As such it seems we should rank her opinions on the matter alongside those of Fictional Fred the Toe-Stabber, who I have decided studied the Economics of HealthCare at the University of Toe-Stabbing. If it seems harsh comparing the opinions of an existing human to a fictional one, remember that the existing one was described as difficult to get along with by other contestants of The Apprentice.  A situation not too far removed from being described as “a bit green” by Kermit the Frog.

Ultimately it doesn’t really matter who Katie Hopkins is (a fact the BBC should quickly realise) as unfortunately her opinion is not an uncommon one. Member of Parliament and practicing GP, Phillip Lee had an opinion about doughnuts. According to Dr Lee, patients who have doughnuts for breakfast should pay for their prescriptions if they develop diabetes.  This was widened to a more general point that people of this generation were less stoic than previous generations, some vague hints that people should pay for illness resulting from their “lifestyle choices” and an astonishing quote on his desire to save money by getting GPs to dispense drugs. According to Dr Lee, there is no need for pharmacists to be involved because “it’s like counting Smarties.”

The last point can be dealt with fairly quickly. Pharmacy and pharmacology is a varied and complex field which takes years of training prior to being allowed to practice. Counting Smarties it isn’t. Although admittedly an ability to count is useful. Perhaps Dr Lee thinks medicine comes from sweet shops.

We also run into problems when deciding on how to charge people for illnesses they have been judged responsible for. Should people pay for medical problems resulting from obesity if they have an unhealthy diet? Lee and Hopkins would say yes. Should smokers who get lung disease pay extra? Again Lee and Hopkins would say yes. Heavy drinkers should pay if they get liver disease? Again that would seem to be a yes. But how much do you have to drink before you pay this premium? How much do you have to smoke or eat? Not everyone who drinks more than they should gets liver disease for example and the amount you have to drink before you’re at risk varies for what is likely to be genetic reasons. How is this accounted for? Does someone who injures themselves falling off a horse have to pay more? After all they decided to go horse riding. If anything choosing an equestrian hobby is more of a “lifestyle choice” than diabetes. The clue being that having diabetes isn’t a lifestyle choice.  Should someone who slips getting out of the shower because they chose not to buy a suitable bathmat have to pay more? You buy the wrong mat, you pay the health cost Lee and Hopkins might shout. And so we see that this system of judging others’ responsibility becomes complex and untenable. The number of injuries resulting from throwing stones in glass houses alone would be ridiculous.

Can people have responsibility for their own health? Of course they can. People should try not to smoke, not to drink too much, exercise, try to avoid being stabbed in the toe and so on. Should they be punished if they don’t do these things? I’d say if they become ill then that’s “punishment” enough. Diabetes isn’t a walk in the park, especially if you develop foot complications. The myriad other complications of obesity, smoking and the like are awful to have and live with. To charge people on top of this seems unnecessary.  It is likely to be argued that the NHS doesn’t have enough money to pay for all these illness and that those who have caused their own illness have a moral responsibility to make up the difference. Putting aside for one moment that people who are said to be ill because of overconsumption of a certain good whether it is food, alcohol or smoking have already paid extra in the form of taxation on those goods, moral responsibility in this area is difficult to judge.

In terms of enacting this strange financial justice we run into another problem. Many health problems and factors considered health risks increase with poverty. So suddenly people would be more likely to have to pay more when in fact they have less money. Julian Tudor Hart, former GP, noticed this tendency for good medical or care to decrease as the need of the population served increased in  his Inverse Care Law and that this especially tends to be the case when medical care is exposed to market forces. Put simply, in the system proposed, people who need medical care most are least likely to get it. If you have to pay extra for treatment and you have no money then you’ll have to stay home (if you’ve got one) and be sick. Perhaps I’m fussy but this seems like a bad thing.

Moral responsibility is the division of actions into those that are good or bad and the attribution of praise, blame, reward or punishment to the agent responsible. It is beyond the scope of this already too lengthy blog post to decide whether the broad spectrum of health acts fall into the simple division of good or bad. Is one glass of one morally wrong? Two? Eight? I’d argue that none of the options are morally wrong although eight is certainly worse for you health wise. That isn’t really the point. The point is that it’s too complex to decide and allocate financial responsibility and ultimately it is not for the health service, doctors, nurses or any health care professional to be judge, jury and financial executioner for health problems patients don’t want and almost certainly didn’t consciously choose. The NHS may be having financial difficulties but applying judgment and discrimination through the weapon of accountancy does not seem to be a viable or ethical way forward. Aneurin Bevan when spearheading the formation of the NHS did so under the belief that treatment “Should be based on clinical need rather than ability to pay” and this to me seems the only morally responsible option. But what do I know? I’ve never been on reality TV.

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2 thoughts on “Ill Judged: The faulty logic of judging the sick.

  1. Apropos the ‘blight upon three generations’, I think the idea is that the generations are born blighted – as in, that is who they are when they enter the world.

    So it is not so much that they are blighted by an outside agency as that they are who they are from the outset.

    I guess a parallel would be a genetic fault passed down the generations.

    P.S. I may be wrong about all of the above – I often speak from half an idea.

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