Letter: Ethical dilemmas that daily confront NHS doctors

Sir: Your leading article 'Wider values of the welfare state' (21 May), expressing guarded support for the restriction of state pensions, ignores the ethical claim of justice. For the last 40 years, those of my generation have contributed faithfully to the state pension fund. When Robert Maxwell chose to use a pension fund to finance other activities within his company he was branded a thief. When the Government does the same thing you argue that 'no universal benefit should be regarded as sacred'.

I cannot understand why, if I have voluntarily paid into a private pension and have been compelled to pay into a state pension fund, I should be denied the benefit of the latter because the terms of the former are generous. Did I not contribute to both? Were not both offered to me on the same basis - pay now and receive benefits later?

On Monday (leading article, 24 May), you complain that 'only saints need apply for NHS treatment'. Never at any time have the Wythenshawe doctors refused to treat smokers because they were the cause of their own illnesses. Indeed, the hospital has a distinguished record of providing first-class treatment to ex-smokers.

They have, validly in my view, reminded patients who continue to smoke that modern medicine is a partnership. If the patient resolutely refuses to play his part in treatment, is not the doctor entitled to ask whether that treatment can be successful and whether, if choice must be made, the patient who chooses to co-operate with the treatment should be given priority over one that does not?

Such an ethical dilemma is worthy of debate. Such debate is not however helped by your confusing it with an entirely different proposition. Ethical debate thrives on independent views, but they do need to be logical and relevant to the issue under discussion.

Yours faithfully,

J. STUART HORNER

Preston

26 May