Health Access

Do you agree that all patients should be entitled to equal access to healthcare whatever their lifestyle choices? This was the motion put forward for last night’s Health Debate, the first of six debates to be held across Ireland in the 2009 Pfizer Health Debates series in association with The Irish Times. These debates on healthcare are open to the general public, free of charge, through advance registration and provide a forum for those attending to articulate perspectives and concerns. I couldn’t resist the temptation.

Last night’s debate was chaired by Irish Times columnist, Fintan O’Toole. Well-known economist, Jim Power argued against the motion along with Prof Charles Normand, professor of health policy and management at Trinity College, Dublin. They went head to head with Labour’s health spokeswoman, Jan O’Sullivan and Dr Donal O’Shea, consultant endocrinologist who spoke in favour of the motion. Before the debate commenced, the chairman asked the audience for a show of hands on the motion. Interestingly, there was fairly equal distribution of those ‘in favour’, those ‘against’ and the ‘don’t knows’.

Did you know that obesity accounts for 40% of all cancers? Add smoking to the equation and it becomes a 70% causal factor. Last night’s debate raised many philosophical as well as practical arguments. Should people who adopt risky lifestyle behaviours like smoking or abusing alcohol, be given the same access to healthcare as people who adopt healthy lifestyles? Is equity of healthcare, a fundamental right for everyone? Should people be judged by their lifestyle choices? How do we define which patients are worthy of treatment? Should our limited resources be put into educating people to change their behaviour? Who decides on these huge moral issues?

diet-shakeThe debate was opened to questions from the floor giving the audience an opportunity for engagement before the final show of hands was taken. The motion was overwhelmingly carried in favour of equal access to healthcare for all patients regardless of lifestyle choice.

I voted against the motion and for good reason. I happen to believe that hard decisions need to be taken to stop the drain put on hospital resources through risky lifestyle behaviours. Look at the problems in A&E with the drunks and drug addicts. Are you happy that they get the same priority of treatment as the genuinely sick and the elderly? Instead of waiting to treat the problems caused by unhealthy lifestyle choices, healthcare resources could be allocated to educating people to take responsibility for their lives. I also believe that people with serious illness are being denying optimum treatment by our failure to prioritise treatment on the basis of genuine need. The poor survival rate in this country for cystic fibrosis sufferers, is the direct result of a system that refuses to make decisions. The cervical screening programme is another example of the failure to prioritise. It was rolled out last year, 21 years after the government first agreed on the need for such a programme. It’s time people woke-up to the fact that patient’s lives are being lost through lack of government leadership. Our health service is rudderless and it remains to be seen if Captain Harney and her First Mate Drumm, will stay with the sinking ship.

The next debate in the series takes place in Cork in UCC, on 29/04/09 and will discuss the hot topic of co-located hospitals. This issue has already generated much discussion nationally so it should be a lively debate.

10 Responses to Health Access

  1. Baino says:

    Oooh Stephie. . now don’t hate me . .I say it as I sees it:

    I’m assuming the motion was “Do you agree that all patients should be entitled to equal access to healthcare whatever their lifestyle choices?” Well yes of course they should!

    I couldn’t agree more about the need for Government to become more responsible with education and prevention and wise spending. But we need to address why people find themselves in these unfortunate positions. Responsibility should also be shouldered by advertisers and providers of legal junk and a serious attempt made to prevent illegal trafficking. It is however erroneous to believe that alcoholism/drugs are significant causes of health system failure. They simply aren’t.

    In Australia – and I can’t imagine Ireland being much different – the top five admission reasons in 2007 were:

    Medical

    * renal dialysis (585,000 admissions)
    * gastroscopy and colonoscopy (152,000)
    * chemotherapy (128,000)
    * normal birth delivery (127,000)
    * rehabilitation (71,000)

    Surgical
    * orthopaedics (224,000 admissions)
    * urology (102,000)
    * plastic surgery (88,000)
    * ophthalmology (76,000)
    * neurosurgery (68,000)

    Blaming the current health problems on a specific demographic is highly charged and I suspect quite eroneous. Ther are far more babies being born and childhood asthmatics being treated each week than drug overdoses!

    We need to be very careful using % as stats, they can be easily manipulated and the samples can be completely warped – alcoholics/addicts presenting in a city hospital for instance would be much more prevalent than in the burbs ..as long as hospitals are funded by the broad tax base, as they are in social democracies like Australia and Ireland health care must be available to all.

    And how do you pick one lifestyle ailment over another . . .Do we stop treating diabetics because they have developed Type 2 as oldies cos they ate badly when they were young? Reject the bowel cancer patient because he didn’t eat a bowl of all bran a day? Toss out the the guy who fell off his motorbike due to speeding, or the stupid kid that swung from a tree rope and is now needing full time care due to a spinal injury. Do we punish the guy with gall stones because he ate too much ice cream as a kid! Or do we stop doing knee replacements and cruciate repairs for the old guy who’s sporting injury is playing up . . do we reject the patient who presents after a car crash because he didn’t have air bags . . of course not! These are all lifestyle choices.

    It’s a ludicrous and offensive proposition to segment patients according to their lifestyle choices especially when we don’t even know if their predicament was a choice! Public health, like education are a right, not a privilege. Alcoholics, smokers (when I last looked that was LEGAL), drug addicts, need help not recrimination and rejection.

    It’s not the SICK that are the problem here, it’s poor administration, poor prioritising, funding and an unwillingness to recognise that the system well and truly broken for a variety of reasons.

    Be careful of instigating a witch hunt here .. the bad guys are in your government. Lining their pockets with your (and the alcoholic/druggies) tax money!

    Alright . . do you still love me?

  2. Steph says:

    Baino – I’m delighted with your response. It proves that debate gets people to think beyond the obvious.

    We’re totally agreed on one thing…

    “It’s not the SICK that are the problem here, it’s poor administration, poor prioritising, funding and an unwillingness to recognise that the system well and truly broken for a variety of reasons.”

    That was the very nub of the argument for those against the motion, including myself.

    Of course everyone should have equal access to healthcare but I believe that this argument is being used to justify the lack of action taken in dealing with the problems in our A&E departments. Important decisions are needed to deal with the crisis so that everyone gets the care they deserve.

    Thanks for entering into the debate, Baino. I love you all the more now! 😀

  3. Grannymar says:

    My answer has to be YES, to the question “Do you agree that all patients should be entitled to equal access to healthcare whatever their lifestyle choices?” If not where do we draw the line. What right have we to play God with others lives?

    Coming from a large family that extended out to numbers greater than you would find in a beehive, I think I have come across a wide & varied collection of illnesses and & health issues. Sometimes these illnesses came with confusing or hidden symptons.

    I know one person that looked and behaved as if he was very drunk. On examination it was discovered that he was in fact very ill and in need of immediate attention, no need for details here. Thankfully he did get that help and is now in full employment and always willing to help his fellow men and women.

    We all have a weak spot, mine could be gallbladder or bronchitis, while for others it might be addiction, age or depression. Only I feel my pain and for me that pain is top priority.

    Modern medicine is wonderful! It is also very cruel because it gives expectations that are not always attainable.

  4. Steph says:

    Grannymar,

    I like your argument. But, here’s another side to it…

    Let’s say you end up in A&E with acute bronchitis and having difficulty breathing. Would you be happy to sit in A&E on an uncomfortable chair for the night surrounded by drunks and drug addicts whose unruly behaviour is denying you the treatment you require?

    Yes, we all deserve access to healthcare but I believe that the present format of EQUAL access, needs stricter interpretation. I’m not talking about playing God, I’m simply saying I feel we need new policies in place to ensure equity and fairness for all.

    Thanks for rolling up your sleeves to join in the debate 😀

  5. Annb says:

    You’ve really got us going on this one – well done Steph.
    I agree with Baino and Grannymar on this, we can’t play God. If we believe in universal health care for all – then, that cannot be a qualified ‘all’ to include only those who live by what is deemed a healthy code. We are all agreed (I think) that the organization of that universal health care is the problem. The system is as unhealthy, sick, irresponsible or clueless as many of the so called drunks and junkies it has to treat. Treat and lead by example I say!

  6. Grannymar says:

    Steph, I have been to A&E several times over the years. Two of those visits were as result of ‘999’ calls and I was seen to and admitted straight away. On others I arrived as a ‘walk in’ patient. On these occasions I went through the triage system and had to wait my turn.

    I actually found that the most stress was caused, not by the staff or other patients, but by those who accompanied them. Complaining about not being allowed to smoke, eating fast food and leaving the remains and packaging on seats or floor for others to clean up and thumping & kicking the drinks machines because it didn’t provide the drinks they wished for. They walk up and down like caged animals often shouting into mobile phones. Really sick people don’t behave like that they are not able to.

  7. Dr.JaneDoe says:

    Perhaps the drunks and drug addicts are there because they took to the bottle after the death of a loved one, or to escape an abusive childhood, or because they were homeless and wanted to escape the pain, or because they were depressed and could not access proper mental healthcare, or because they lost their jobs and couldn’t cope etc etc.

    This is extremely judgmental. These problems are social problems that go on to cause medical problems in many, many cases, and though these people may be annoying, and abusive, they need help and are not to blame. We should be saying “there but for the grace of God, go I”, not “Should we treat them?”.

    Healthcare is a human right. We need more funding directed towards it so these sorts of discussions are not even contemplated.

    With respect to the “sitting with acute bronchitis surrounded by drunks” scenario-the problem there is NOT the drunks. The problem is-you shouldn’t BE sitting in an A&E all night. You should be seen, admitted and treated in a timely manner, with adequte resources. And this requires funding, staff, equipment, and beds.

    Provision of care to the sick, distressed, mentally ill, or dying should never, never, never be influenced by discrimination in any way. Age, sex, occupation, previous convictions, sexual preferences, dietary preferences, liking for the sauce/drugs-none of this matters. There should be a health service sufficient to provide for our population. And if there isn’t-it’s not the fault of any member of that population. It’s a fault of the providers.

  8. I’m going to have to disagree with you on this one, Steph.

    Just because a healthcare system is in crisis doesn’t mean that those who have made bad lifestyle choices should be excluded or punished in anyway. We may never know what prompts people to follow “irresponsible” lifestyles – there may be a history of child abuse or neglect, there may trauma – people are generally only self destructive because they’re in trouble – so… is it fair to deny them access to healthcare? I think not. Their “lifestyle” choices may be the result of “unseen” illnesses of the psyche and soul. They need care just as much as anyone else.

    It is just not right, under any circumstance, to discriminate – or to judge.

    The problem here is less about lifestyle choices and more about a medical system that is failing. That’s what needs to be addressed first and foremost. Provide the proper care to ALL who need it and perhaps then the need for for medical attention may fall by default.

  9. Steph says:

    Hi! folks – I’m back! Thanks to one and all for your views. It’s really great to get a response like this.

    Based on the outcome of the vote on the night, I knew when I wrote this post that my viewpoint was likely to prove unpopular. Before the debate started I voted in favour of the motion because just like you guys, I fundamentally believe that everyone should have equal access to healthcare whatever their situation. However, having listened to the debate ‘against’, I changed my mind for the reasons which I’ve already stated above. I accept that it may appear judgemental but my views stem from the frustration I feel at the state of the health service and from the awful stories I hear regularly from other patients.

    The disgraceful situation for cystic fibrosis patients in Ireland is a classic example of all that’s wrong with our health service and the news in today’s Irish Times, does nothing to allay my fears…

    HSE postpones promised new cystic fibrosis patients’ facility…

    http://www.irishtimes.com/newspaper/frontpage/2009/0327/1224243553913.html

    Trading people’s lives for economic survival is sick and heartless – Orla Tinsley (CF patient)…

    http://www.irishtimes.com/newspaper/opinion/2009/0327/1224243552720.html

    I accept that maybe I’m wrong to equate the mismanagement of our health service with society’s ills but my reaction is born out of frustration rather than anything else.

    Thanks everyone for joining in the debate!

  10. […] Jump to Comments Dot writes: The Biopsy Report has an interesting post on the debate over access to health-care – should people whose problems can […]

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