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In UK survey, doctors support denying treatment to smokers, the obese

A majority of doctors in a United Kingdom survey supported measures to deny non-emergency medical services to smokers and the obese, The Observer newspaper reported Sunday.

Although the survey by the networking website doctors.net.uk was a self-selecting poll, the site's chief executive called the response "a tectonic shift" for the profession.

The results feed into a British debate about "lifestyle rationing" by the National Health Service, the Observer reported.

The survey by doctors.net.uk, which claims nearly 192,000 members, found that 593, or 54 percent, of the 1,096 doctors who participated answered yes to this question: "Should the NHS be allowed to refuse non-emergency treatments to patients unless they lose weight or stop smoking?"


Doctors who approved gave a few examples, The Observer said:

  • Denying in-vitro fertilization to childless women who smoke was justified because the procedure was only half as successful for them as for non-smokers.
  • Obese or alcoholic patients should be expected to change their behaviors before undergoing liver transplant surgery.

Doctors and patients who oppose lifestyle rationing call the approach blackmail that denies the sick their human rights, The Observer said.

Dr. Tim Ringrose, doctors.net.uk's chief executive, told The Observer the findings represent a significant change in doctors' attitudes, considering that the health service must save 20 billion pounds ($32.5 billion) by 2015.

"This might appear to be only a slim majority of doctors in favor of limiting treatment to some patients who fail to look after themselves, but it represents a tectonic shift for a profession that has always sought to provide free healthcare from the cradle to the grave," Ringrose said.

Dr. Clare Gerada, chair of the Royal College of General Practitioners, told The Observer the NHS should deliver care according to need.

“Clearly, giving up smoking is a good thing,” Gerada told The Observer. “But blackmailing people by telling them that they have to give up isn't what doctors should be doing."

Clinical advice about lifestyle changes are another matter, other doctors said.

"Lifestyles contribute to risk and sometimes they may make treatments too risky to undertake,” John Saunders, chair of the Royal College of Physicians ethics committees, told The Observer. “But that's quite different to saying, 'I'm not going to give you surgery because you smoke or are overweight.'"

Some UK private care trusts already ban in-vitro fertilization, breast reconstructions and hip and knee replacements for smokers and the obese, The Observer said.

Dr. Michael Ingram, chair of Red House Clinical Commissioning Group in Hertfordshire, last month wrote in the doctors' website Pulse that "Rationing is dressed up as science."

"Where does this go next? Will we deny IVF to those who have had pelvic inflammatory disease because of its association with sexual promiscuity?" Ingram wrote.

In the United States, debates have been held on withholding liver transplants for alcoholics and coronary artery bypass surgery for smokers, although no ban is in place.

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