Doctors will get right not to treat self-inflicted illnesses

Doctors are to be issued with new guidance permitting them to refuse to treat a patient if they judge that an illness is self-inflicted.

The guidelines will be introduced as a poll shows that one in five doctors admits that he or she has already denied patients treatment because they drink heavily, smoke or are obese.

This weekend Sir Michael Rawlins, chairman of the National Institute for Health and Clinical Excellence (Nice) said the guidelines would ensure that the limited National Health Service budget was well spent.

He singled out alcoholics by saying the institute’s new social value judgments will make it clear that if patients continue to drink they will not be given a liver transplant.

“Alcoholism rots the liver and if the patient is going to continue drinking, giving them a liver when there is already a shortage of organs is not a sensible use of resources,” Rawlins said.

“We are not punishing alcoholics, it is just that it is pointless spending all that money and using a liver that could be used for someone else.”

The poll of more than 400 doctors for the medical website Doctors.net.uk found that 19% of respondents had withheld treatment because of a patient’s unhealthy lifestyle.

Dr Julian Randall, a GP in Dudley, in the West Midlands,said he had denied treatment to a smoker: “Vascular surgery on a patient who still smokes is almost certainly doomed to fail. Unless the limb needs to be saved immediately, I refuse to refer them until satisfied that their condition is no better after six months of not smoking.”

Randall added: “In Dudley we lost a vascular surgeon, which has increased the waiting list. The remaining surgeons will need to prioritise the patients they operate on. We delay operating on those who are still smoking to take pressure off.

“I tell patients, ‘It is the wicked weed that has caused this. You will develop gangrene unless you stop’. My end of the bargain is to refer them to smoking cessation clinics.”

The Nice guidelines state that care cannot be denied simply on the grounds that a condition is self-inflicted. However, according to a draft of the code to be debated next week, the treatment can be withheld if the patient’s lifestyle affects the success or cost effectiveness of the operation.

Last week primary care trusts in east Suffolk ruled that obese patients will no longer be given hip and knee replacements on the NHS. GPs and consultants agreed not to refer anyone with a body mass index (BMI) of more than 30 to a specialist until they lose weight.

Brian Keeble, director of public health for Ipswich Primary Care Trust, said the new Nice guidance is in line with the approach taken in east Suffolk. “This decision was driven by the consultants who carry out the operations that fail. There was a feeling that we were not using resources wisely as these hips needed to be redone,” he said.

“If the condition is not life-threatening, we need our patients to get their weight down before the operation.This may also apply to other specialities. Doctors up and down the country are beginning to look at this.”

The Sunday Times ~ November 27, 2005