Introduction
Smoking is a common lifestyle and cultural practice since its sharp rise to fame in the 1890s as the tobacco industry was sprung to life by James B. Duke due to the formation of his tobacco company (American Tobacco Company) in 1890 (Sebelius and Koh 2014). This is a staple of cigarette manufacture and other companies led in his footsteps and soon, cigarettes made their way to (the United Kingdom). Cigarettes have been used and manufactured religiously since this time and not only did they bring money into a booming economy; it dragged numerous health complications with it also, ranging from cancer to Chronic obstructive pulmonary disease (COPD). In this essay, I will investigate and discuss numerous sources of evidence and opinions to establish whether people who smoke should have limited access to the NHS.
Main Body
People should not have limited access to the NHS if they smoke
The main issue that is flagged by 'People should have limited access to the NHS if they smoke' is that it goes against what the NHS stands for, and the pillars of medical ethics. If people should receive limited care from the NHS because they smoke, then by the same understanding and logic, those that worsen their health through other means such as drinking excessive amounts of alcohol should too. The NHS was constructed for the many and should not be confined to the few by treating separate groups of people unfairly.
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There are four pillars of medical ethics, beneficence, non-maleficence, autonomy, and justice. These are guidelines that all healthcare professionals of the NHS are expected to follow and live up to. The definition of justice in this context is 'The ethical principle that persons who have similar circumstances and conditions should be treated alike; sometimes known as distributive justice' (Medical Dictionary. 2021). Therefore, if we are providing limited care to those that smoke, we are treating them unfairly, and we are directly breaching this pillar of medical ethics if we begin to discriminate against this group of people then who is to say that the NHS will not start to discriminate other groups of people such as the elderly. As well as this, autonomy means 'A patient's personal independence, of being self-governing' (Medical Dictionary. 2021). This could be interpreted as the patient's right to conduct and live their life in any way they see fit e.g., smoking as a daily habit. This exclaims that people should be allowed to smoke, without any judgment from healthcare professionals and that they should be treated fairly and equally to everyone else - meaning that despite their lifestyle choices the NHS should not limit the level of care that they receive, even when they put themselves in that position by smoking.
In addition to this, there are six values of the NHS that each healthcare professional is expected to follow during their occupation. These are: working together for patients, respect and dignity, commitment to the quality of care, compassion, improving lives and everyone counts (Values of the NHS Constitution. 2021). If we begin to discredit these values of the NHS constitution by disrespecting patients' rights to self-determination then the NHS itself will become disrespected and over time this will have a worse effect on the economy and the public than limiting care for those who smoke.
Moreover, it is difficult to establish whether smoking is the sole cause of a patient's illness, the main disease being lung cancer. It would also be unfair to deny someone treatment for cancer if they smoke as they may not smoke as much as other people and the cause of the cancer was therefore not only down to smoking. Subsequently, the causes of lung cancer and other diseases are not just the result of smoking and are also possibly the result of other lifestyle choices or conditions out of their control such as second-hand smoke. Therefore, it would be unjust to provide limited access to the NHS just on the basis that they smoke. However, the mortality of smoking-related lung cancer is increased in comparison to those that do not smoke - 'smoking is responsible for a third of cancer deaths' (Sasco, Secretan, and Straif, 2004)
Furthermore, smoking is not the only practice that is costly to the NHS, other choices such as excessive eating and overconsumption of alcohol also cost the NHS billions of pounds which is detrimental, especially during the Covid-19 pandemic. Alcohol-related conditions cost the NHS £3.5 billion per year, which is approximately 3.6% of the NHS annual allotted budget (NHS 2019). In 2014 - 2015, it was calculated that obesity-related illness cost the NHS £6.1 billion (Health Matters: obesity and the food environment. 2017). The cost of smoking-related illness to the NHS in 2015 was £2.6 billion (Cost of smoking to the NHS in 2015. 2017). Using this information, it is clear to see that smoking should be the least of our concerns when it comes to punishing lifestyle choices in regard to healthcare as there these other issues are costing the NHS a considerable amount more than that smoking. Therefore, only limiting access to smokers would not improve the situation of the NHS by much and would most likely cause more harm than good due to the social issues this act would rise.
As well as this, the percentage of smoking is decreasing year by year. (Windsor-Shellard et al. 2020)
Using this data, you can see a clear decline in the percentage of people smoking and it is projected that this will only continue to decrease. Therefore, it would seem pointless to provide limited care to those that smoke when eventually the number of smokers is going to be minute and irrelevant - and will not be costing the NHS much money let alone more money over the years.
People should have limited access to the NHS if they smoke
Smoking is a lifestyle choice that over time causes many diseases and illnesses to those that smoke. It is unfair that people who do not smoke get treated the same as those who choose to damage their bodies while maintaining this habit. Smoking has been a staple of self-inflicted diseases for decades.
Every choice we make in life comes with consequences, and we are forced to deal with these consequences whether they are good or bad. This should be the same with smoking and the damage it does to your body. The NHS should not be a lifeline crutch for those that continue to damage their bodies by smoking as we learn through the consequences of our actions if we continue to 'cure' smoking-related illness, then those who smoke will continue to do so and the NHS will continue to struggle with funding as it has over the years, especially during the COVID-19 pandemic. If the NHS continues to struggle financially then possibly more of the NHS will become privatized and slowly the population will have to begin to pay directly for their healthcare, rather than being taxed.
Cigarettes contain a highly addictive substance called Nicotine; this is what causes people to smoke as much as they do. Therefore, people should be required to quit smoking before receiving treatment. However, the probability of them relapsing and starting smoking again is high - 55.4% in the US (United States) made a 'quit attempt.' 55.4% failed to quit smoking and smoked since trying to quit (Babb et al. 2017). As the percentage of people smoking over the years is decreasing it would be more beneficial to provide limited care to those that smoke, and instead redirect the saved funds to helping these people quit smoking. If this is successful then more money would be saved thus further helping the NHS - not only would this help the NHS it would also improve the wellbeing of the general population and discourage other self-damaging habits e.g., drugs.
The NHS when it was first founded in 1948 spent £11.4 billion on healthcare, whereas in 2010 - 2011 it spent £121 billion (Harker, 2012). This is over 10 times the amount originally spent in 194. Despite inflation, this figure is only made worse by providing full access to the NHS for those that smoke. If we provided limited care to those that smoke then the NHS would be saving £3 billion every year and this can be directed to help people who are suffering due to no fault of their own. As well as this, not only would limiting care to those that smoke provides more money to the NHS, but it would also deter individuals from the use of cigarettes. In addition to this, imposing this decision on the public could also encourage the general population to take better care of their bodies (more exercise, less drug use, etc.), this would have a knock-on effect meaning overall less money from the NHS would be spent on self-inflicted diseases and more money can be spent on conditions out of the patients' hands.
Funding is not the only issue that the NHS struggles with, bed space is also an issue that is especially prevalent during the Covid-19 pandemic where most hospitals physically do not have the capacity to admit people. One in twenty hospital beds is used by patients with a smoking-related illness (Cancer research. 2012); during Covid-19 this is a massive number of people using up beds because of their own doing, rather than using those beds to treat people who have unfortunately contracted the virus against their best efforts. Continuing to provide care to people that put themselves in their position could mean the death harm of a fit individual which many believe is unfair - in 2015 '52% of people think the NHS should not fund treatment if an illness is a direct consequence of smoking' (UniMed. 2018). The NHS is funded by the taxes of the working people and as smoking is a minority, this means that the majority are forced to pay for the consequences of others' actions. This is important because the percentage of people smoking has been declining over the years but people still feel that the NHS is too generous in providing full access to those that smoke.
Conclusion
In conclusion, after debating both sides of this question it is fair to conclude that there are numerous credible reasons for both sides of the question. It is important to assess the detrimental effects of the outcomes of each scenario. If we provide limited care then the social injustice of the NHS comes into question and the NHS constitution and the values we as healthcare professionals must follow every day, fall into disarray. However, on the other hand, if we do not provide limited care to those that smoke then the NHS could continue to combat its financial struggles and bed space day in and day out. Consequently, it is impossible to impose not impose such a decision without upsetting at least one group of people. Therefore, making it very difficult to put such an idea into practice despite the possible financial and social benefits of doing so.
Reference list
- Babb, S. et al. 2017. Quitting Smoking Among Adults - United States, 2000-2015. MMWR. Morbidity and Mortality Weekly Report 65(52), pp. 1457-1464. doi: 10.15585mmwr.mm6552a1.
- Cost of smoking to the NHS in 2015. 2017. Available at: https:www.gov.ukgovernmentpublicationscost-of-smoking-to-the-nhs-in-england-2015cost-of-smoking-to-the-nhs-in-england-2015 [Accessed: 24 November 2021].
- Harker, R., 2012. NHS Funding and Expenditure. [online] Fullfact.org.
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