Jeremy Laurance: ‘NHS care isn’t just a right – we have a duty to use it wisely’

Medical Life

A reader writes to topple me from my moral high horse. In a piece last week (“Doctors are there to help patients – not judge them”, Comment, 16 February), I wrote that the delivery of medical care must be non-judgemental if it is to be humane. This was in the context of figures showing that almost one-quarter of liver transplants last year were carried out on alcoholics.

To suggest that heavy drinkers were the authors of their own destruction and therefore in some sense less deserving than others was dangerous ground, I argued, and could lead us to discriminate against almost anyone – smokers, the obese, mountain climbers and so on.

Sally, as I shall call her, took a different view. Her husband died of alcohol-induced liver failure 20 years ago. He was just 50 and although liver transplants were relatively new then, he was considered for one – and rejected.

Sally wrote: “I well remember the trepidation with which the consultant broke the news that they were not going to attempt a transplant in our case – and his surprised relief when I said I thought he was quite right. My husband ... had tried to overcome [his] demons … but his one serious attempt to give up drinking led ultimately to a precipitous descent into the daily two bottles of spirits that killed him within five years. I knew he would not be able to deal with the regime needed to cope with a new liver and felt that it would be wrong to prolong his life for a year or two when there were other patients who did not have an alcohol problem and thus stood a better chance of a successful outcome.”

We often hear from patients (and organisations representing them) protesting at the denial of their “right” to NHS care. It is rare to hear from someone defending a decision to withhold care. Yet Sally makes an important point – as patients, we have duties as well as rights; duties to use NHS resources put at our disposal wisely and effectively. We must recognise our responsibility not to grab everything we can and not to demand what the NHS cannot afford, regardless of its impact on others.

Last year, the writer and broadcaster Libby Purves wrote about her mother, a 90-year-old with a failing heart, who was offered an operation to replace a leaky valve. She turned the offer down, observing that it would be “unseemly” when others had greater needs. What a dignified response.