Leading Article: Only saints need apply for NHS treatment

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THE CURRENT issue of the British Medical Journal carries some lively letters about whether coronary bypass surgery should be denied to smokers. Some cardiothoracic surgeons believe that only non-smokers, or smokers who have given up before treatment, should be operated on because they have a much better chance of recovering. To operate on those who continue recklessly to smoke is, they believe, a misuse of scarce resources.

If Virginia Bottomley, the Secretary of State for Health, is seriously interested in reducing the costs of the NHS, she should commission an inquiry into the potential benefits of this approach. The through-put of hospitals could be reduced to a fraction of the present levels if all those suffering from self-inflicted illnesses or injuries were refused treatment.

After smokers, anyone suffering from drink-related problems such as cirrhosis of the liver would naturally have to be turned away until they had mended their ways. Likewise drug-addicts, whose self-abuse also causes heart damage. The overweight would have to come under close scrutiny. Those whose obesity was due to endogenous factors, such as a poor metabolic rate or some glandular malfunction, would qualify for medical attention. Not so those who simply eat or drink to excess.

The wisdom of the ethics committee of the British Medical Association would be much tested in the field of sexually transmitted diseases. Fine judgement would be required in deciding whether making love was a necessary human activity or a form of self-indulgence. Some forms of sexual intercourse might perhaps be deemed not to exclude those who performed them from treatment, should any form of disease or infection result. For others, treatment would be, as they say, contraindicated.

Those who clog up hospital casualty departments every Saturday afternoon thanks to their addiction to sport need expect no mercy, especially those in high-risk activities such as skiing and all forms of football. Only those who pledged to desist from thus putting themselves at risk could expect to have broken legs set, heads stitched and so on. Some tact, likely to be a dwindling commodity in this slimline NHS, would be required in dealing with victims of depression. Only those whose state was clearly attributable to a defective life- style could reasonably be told to get their act together and cheer up.

In this new era, doctors would become the supreme moral arbiters. As in Samuel Butler's satirical novel Erewhon, morality would soon be equated with health and beauty, illness would be associated with immorality, if not (as in Erewhon) with actual crime. Admission to hospital would be seen as a certificate of clean and considerate living - and the company there would surely be very dull.