Jeremy Laurance: Doctors are there to help patients – not judge them

The ‘transplants for drinkers’ row has divided medical opinion

Share
Related Topics

I am sure that Don Foster, the Liberal Democrat shadow culture secretary, is a compassionate human being and not the sort to first assess whether a drowning man is deserving of his assistance before throwing him a rope. What then is the explanation for his decision to release figures highlighting the growth in liver transplants that show that one in four now go to people who abuse alcohol?

Of 151 liver transplants carried out in 2007-8, the highest total for a decade, 35 (23 per cent) were performed on alcoholics. Mr Foster's stated intention was to draw attention to Britain's "binge-drinking culture" and the impact that alcohol is having both on the NHS and on the health of the people affected.

"The Government has made endless pronouncements about tackling alcohol misuse but has failed to take any real action. Ministers are sitting on their hands while irresponsible retailers continue to sell alcohol at pocket money prices," he declared.

There can be no quarrel with this claim, which is a self-evident truth. But a politician of Mr Foster's experience can surely not have believed that it would have been enough to project his discovery on to the front pages of the weekend's newspapers.

What made Mr Foster's intervention particularly controversial was the implied criticism, that scarce NHS resources were being used to save the lives of people who were the authors of their own destruction.

That turned a dull set of figures into a row over "transplant organs for drinkers". The mother of a young woman who died in a car crash and whose organs were donated after her death was quoted in one newspaper as saying she found the idea "offensive."

"If there are two people side by side wanting a liver and one is an alcoholic and one isn't, there's no contest – you take the one who is not an alcoholic, they are more entitled," she insisted.

In saying this she was reflecting the opinion of a wide swath of Middle England. The suggestion that some patients may be more deserving than others has divided lay and medical opinion for decades. Should smokers be treated equally with non-smokers? Do obese people deserve sympathy or blame? And what of those who ride motorcycles or climb mountains, knowing that they are dangerous activities?

The difficulty with this approach is obvious. Almost anyone who is ill can, in some measure, be judged to have brought their illness on themselves. That is why the National Institute for Clinical Excellence wisely ruled out discrimination on this ground, in guidance issued more than three years ago. Care must be non-judgmental if it is to be humane.

But there are exceptions. One is when the patient imperils the success of a treatment by continuing with the behaviour that made them ill in the first place. A smoker in need of heart surgery who refuses to give up tobacco puts himself at risk because his habit increases the likelihood of blood clots resulting from the operation, which could kill him. On those grounds, surgery might reasonably be denied.

This is a judgement about the balance of risk and benefit, and is taken with the sole interests of the patient in mind. It is not a judgement about whether he or she is a "deserving" case.

A trickier problem is where the ethical duty to treat all patients according to their need conflicts with the duty to provide equally for all patients. In a health service with a limited budget doctors have a duty to use resources efficiently – and that means not wasting them on a patient unlikely to benefit.

When George Best, who died aged 59 in 2005, was spotted drinking after his liver transplant in 2002 he was rightly criticised. There is a shortage of organs and a transplant involves a huge commitment of NHS resources. There is no better way for anyone lucky enough to have received one to show their gratitude than by looking after it.

But to turn this into an obligation leads into difficult territory. It is one thing to require a smoker to give up in order to prevent clots blocking the fresh blood vessels being stitched to his heart. It is another to order a motorcyclist to sell his machine after he has been put back together by surgeons.

Clinical decision-making must not shade into social engineering or doctors will become even more God-like than they already are.



Jeremy Laurance is the Health Editor of 'The Independent'

React Now

  • Get to the point
Latest stories from i100
Have you tried new the Independent Digital Edition apps?
iJobs Job Widget
iJobs General

Recruitment Genius: Project Implementation Executive

£18000 - £23000 per annum: Recruitment Genius: They work with major vehicle ma...

Recruitment Genius: Chiropractic Assistant

£16500 per annum: Recruitment Genius: A Chiropractic Assistant is needed in a ...

Recruitment Genius: Digital Account Executive - Midlands

£18000 - £26000 per annum: Recruitment Genius: They work with major vehicle ma...

Recruitment Genius: Web Developer

£28000 - £30000 per annum: Recruitment Genius: This company provides coaching ...

Day In a Page

Read Next
 

Errors & Omissions: how to spell BBQ and other linguistic irregularities

Guy Keleny
 

South Africa's race problem is less between black and white than between poor blacks and immigrants from sub-Saharan Africa

John Carlin
NHS struggling to monitor the safety and efficacy of its services outsourced to private providers

Who's monitoring the outsourced NHS services?

A report finds that private firms are not being properly assessed for their quality of care
Zac Goldsmith: 'I'll trigger a by-election over Heathrow'

Zac Goldsmith: 'I'll trigger a by-election over Heathrow'

The Tory MP said he did not want to stand again unless his party's manifesto ruled out a third runway. But he's doing so. Watch this space
How do Greek voters feel about Syriza's backtracking on its anti-austerity pledge?

How do Greeks feel about Syriza?

Five voters from different backgrounds tell us what they expect from Syriza's charismatic leader Alexis Tsipras
From Iraq to Libya and Syria: The wars that come back to haunt us

The wars that come back to haunt us

David Cameron should not escape blame for his role in conflicts that are still raging, argues Patrick Cockburn
Sam Baker and Lauren Laverne: Too busy to surf? Head to The Pool

Too busy to surf? Head to The Pool

A new website is trying to declutter the internet to help busy women. Holly Williams meets the founders
Heston Blumenthal to cook up a spice odyssey for British astronaut manning the International Space Station

UK's Major Tum to blast off on a spice odyssey

Nothing but the best for British astronaut as chef Heston Blumenthal cooks up his rations
John Harrison's 'longitude' clock sets new record - 300 years on

‘Longitude’ clock sets new record - 300 years on

Greenwich horologists celebrate as it keeps to within a second of real time over a 100-day test
Fears in the US of being outgunned in the vital propaganda wars by Russia, China - and even Isis - have prompted a rethink on overseas broadcasters

Let the propaganda wars begin - again

'Accurate, objective, comprehensive': that was Voice of America's creed, but now its masters want it to promote US policy, reports Rupert Cornwell
Why Japan's incredible long-distance runners will never win the London Marathon

Japan's incredible long-distance runners

Every year, Japanese long-distance runners post some of the world's fastest times – yet, come next weekend, not a single elite competitor from the country will be at the London Marathon
Why does Tom Drury remain the greatest writer you've never heard of?

Tom Drury: The quiet American

His debut was considered one of the finest novels of the past 50 years, and he is every bit the equal of his contemporaries, Jonathan Franzen, Dave Eggers and David Foster Wallace
You should judge a person by how they peel a potato

You should judge a person by how they peel a potato

Dave Hax's domestic tips are reminiscent of George Orwell's tea routine. The world might need revolution, but we like to sweat the small stuff, says DJ Taylor
Beige is back: The drab car colours of the 1970s are proving popular again

Beige to the future

Flares and flounce are back on catwalks but a revival in ’70s car paintjobs was a stack-heeled step too far – until now
Bill Granger recipes: Our chef's dishes highlight the delicate essence of fresh cheeses

Bill Granger cooks with fresh cheeses

More delicate on the palate, milder, fresh cheeses can also be kinder to the waistline
Aston Villa vs Liverpool: 'This FA Cup run has been wonderful,' says veteran Shay Given

Shay Given: 'This FA Cup run has been wonderful'

The Villa keeper has been overlooked for a long time and has unhappy memories of the national stadium – but he is savouring his chance to play at Wembley
Timeless drama of Championship race in league of its own - Michael Calvin

Michael Calvin's Last Word

Timeless drama of Championship race in league of its own