Controversial U.K. Policy Withholding Surgery from Smokers and Obese Patients

The United Kingdom’s county of Hertfordshire has expanded a controversial health care policy that withholds surgery from patients who are obese or who smoke. The policy was originally implemented in 2011 and, at the time, only applied to hip and knee operations. In 2012, it was expanded to include other non-urgent routine surgeries. Under the policy, patients were banned from having surgery for a specific period of time as an effort to urge them to improve their health by losing weight or quitting smoking in order to become eligible for surgery. However, the most recent expansion of the policy is labeled as an “indefinite” ban on all routine surgeries until the patient’s health is improved.

Proponents assert that the expanded policy will help patients improve their health while also alleviating the county’s health care budget and reducing length of hospital stays. Opponents, however, argue that the policy is unethical.  One professor of psychology, Robert West, has expressed that “[r]ationing treatment on the basis of unhealthy behaviors betrays an extraordinary naivety about what drives those behaviors.” Although reducing obesity and smoking prior to any surgery is beneficial to a patient’s recovery, it remains unclear whether withholding surgery altogether is actually successful in improving overall health.

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Must Doctors Comply with Unconventional Requests of Patients?

A growing interest in “transhumanism” has presented an ethical dilemma for doctors. Individuals, like the bioartist Stelarc, are seeking surgeons who will perform unconventional procedures such as surgically implanting an ear on a forearm. For various reasons, most doctors are unwilling to perform these procedures. However, bioethicist, Francesca Minerva, argues that doctors should comply with these requests as long as they are legal.  According to Minerva, it is not the responsibility of individual physicians, but the responsibility of the government to determine whether or not such procedures are beneficial to society.  She further explains that, until the government makes such determination by promulgating new laws and regulations, denying individuals the opportunity to “enhance” their bodies violates patient autonomy.

From Bioedge, “Is it ethical to refuse a patient surgery for body art?”

Excerpt from article:

‘According to the basic principle of respect for autonomy, patients are entitled to decide if undergoing a certain treatment is in their best interest. And what constitutes one’s best interest is, at least in large part, based on one’s own assessment.’ If a request is legal, an ethical doctor must comply.

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