I've seen a few reports of angry smokers / drinkers who've been denied
treatment because the surgeon didn't want to treat someone who was
only going to get ill again.

I haven't seen any coverage about people being denied surgery after
attending A&E following an episode of deliberate self harm. (Although
it is easy to find horror stories about how people have been treated in
A&E after DSH.)

I'd be interested to know if there's any laws about who a surgeon
should treat, and when they can deny treatment.

I'd be very interested to hear about any past cases where someone was
denied treatment because of their medical history ("You've done it
before, you'll do it again, there's no point in the surgery"),
especially if this followed a case of DSH.

(For the record, the real world case is not interested in taking any
legal action, or writing to PALS, or writing to PPI forums.)

In article .com,
says...
I've seen a few reports of angry smokers / drinkers who've been denied
treatment because the surgeon didn't want to treat someone who was
only going to get ill again.

I haven't seen any coverage about people being denied surgery after
attending A&E following an episode of deliberate self harm. (Although
it is easy to find horror stories about how people have been treated in
A&E after DSH.)

I'd be interested to know if there's any laws about who a surgeon
should treat, and when they can deny treatment.

I'd be very interested to hear about any past cases where someone was
denied treatment because of their medical history ("You've done it
before, you'll do it again, there's no point in the surgery"),
especially if this followed a case of DSH.

(For the record, the real world case is not interested in taking any
legal action, or writing to PALS, or writing to PPI forums.)



I think the issue here would be whether treatment is of the elective
variety or not. Self harmers need attention to injury whereas a smoker
who needs cardiac or lung surgery isn't on the gurney, needing immediate
attention.

If that smoker presented at casualty with a heart attack, needing
immediate surgical intervention, then that would be a different scenario
to one at an out patients clinic being asked to stop before he or she
gets that bypass.

self harmers would come into the category of needing emergency treatment
and not elective.

FR

"bealoid" wrote in news:1168091838.312337.254010
@s80g2000cwa.googlegroups.com:

I've seen a few reports of angry smokers / drinkers who've been denied
treatment because the surgeon didn't want to treat someone who was
only going to get ill again.

I haven't seen any coverage about people being denied surgery after
attending A&E following an episode of deliberate self harm. (Although
it is easy to find horror stories about how people have been treated in
A&E after DSH.)

I'd be interested to know if there's any laws about who a surgeon
should treat, and when they can deny treatment.

I'd be very interested to hear about any past cases where someone was
denied treatment because of their medical history ("You've done it
before, you'll do it again, there's no point in the surgery"),
especially if this followed a case of DSH.

(For the record, the real world case is not interested in taking any
legal action, or writing to PALS, or writing to PPI forums.)


Any clinician can use his/her clinical judgement in deciding when and how
any patient can and should be treated. In fact, the clinician is
REQUIRED to use his/her clinical jusgement in treating a patient.

If you consider that a clinician's clinical judgement is faulty, you can
make a formal complaint to his/her employers (the NHS Trust etc) and/or
to the professional body to which he/she belongs (all clinicians must
belong to a professionsl body).

There is no "law" that says a surgeon must operate when in his/her
opinion the surgery will be less effective because the patient declines
to give up smoking. But, of course, any surgeon (or any other doctor)
must take all possible actions to save the life of a person in his/her
care.

In the case of self-harmers, the repair of the damage could well be
considered an "emergency procedure" which would take place irrespective
of the patient's smoking history - just as any "emergency procedure"
would be carried out on anyone attending A&E, smoker or not. This
paragraph is my opinion.

Terry W

Terry W. wrote:
"bealoid" wrote in news:1168091838.312337.254010
@s80g2000cwa.googlegroups.com:

[snip]

I'd be very interested to hear about any past cases where someone was
denied treatment because of their medical history ("You've done it
before, you'll do it again, there's no point in the surgery"),
especially if this followed a case of DSH.

[snip]

There is no "law" that says a surgeon must operate

To be clear: I'm not asking for laws, I'm asking for details of civil
cases.

But, of course, any surgeon (or any other doctor)
must take all possible actions to save the life of a person in his/her
care.

"Of course"?

In the case of self-harmers, the repair of the damage could well be
considered an "emergency procedure" which would take place irrespective
of the patient's smoking history - just as any "emergency procedure"
would be carried out on anyone attending A&E, smoker or not. This
paragraph is my opinion.

I'm not sure I understand this last paragraph. I'm not saying that
people who smoke don't get treated after presenting with DSH, I'm
saying that people who self-harm sometimes don't get surgery after A&E
admits them after DSH.

On Jan 6, 6:45 pm, "bealoid" wrote:
Terry W. wrote:
"bealoid" wrote in news:1168091838.312337.254010
@s80g2000cwa.googlegroups.com:[snip]

I'd be very interested to hear about any past cases where someone was
denied treatment because of their medical history ("You've done it
before, you'll do it again, there's no point in the surgery"),
especially if this followed a case of DSH.[snip]

There is no "law" that says a surgeon must operateTo be clear: I'm not asking for laws, I'm asking for details of civil
cases.

But, of course, any surgeon (or any other doctor)
must take all possible actions to save the life of a person in his/her
care."Of course"?

In the case of self-harmers, the repair of the damage could well be
considered an "emergency procedure" which would take place irrespective
of the patient's smoking history - just as any "emergency procedure"
would be carried out on anyone attending A&E, smoker or not. This
paragraph is my opinion.I'm not sure I understand this last paragraph. I'm not saying that
people who smoke don't get treated after presenting with DSH, I'm
saying that people who self-harm sometimes don't get surgery after A&E
admits them after DSH.

As someone who has some personal experience as a user of the mental
health services, I have had never heard that surgery has been refused
when someone has deliberately self-harmed - can you describe precisely
what you are referring to.

I do recall 20 years ago when I took an overdose, that it wasn't very
pleasant when the doctor forced the tube down my throat when they were
pumping my stomach.

But then again once that had happened one would think twice about doing
it again.

Of course, a doctor is there to save lives and it must be difficult
treating someone to save their lives when their actions would indicate
they don't want to be saved.

But let us get this straight, you are talking about emergency treatment
in A & E. I would have thought that many people wouldn't be treated in
A & E if the attitude was taken that they had brought their injury on
themselves in one way or another.

Nick

Nick wrote:

As someone who has some personal experience as a user of the mental
health services, I have had never heard that surgery has been refused
when someone has deliberately self-harmed - can you describe precisely
what you are referring to.

[snip]

But let us get this straight, you are talking about emergency treatment
in A & E. I would have thought that many people wouldn't be treated in
A & E if the attitude was taken that they had brought their injury on
themselves in one way or another.

I see that I haven't been clear enough, so here's an example:

Fred self harms.
Fred goes to A&E. Fred gets excellent treatment from A&E. The A&E
doctor tells Fred that Fred has caused some damage that requires
surgery. This could include, for example, damage to tendons.
A&E admit Fred to a ward in the hospital.
All the staff in the ward give Fred excellent care.
The A&E doctor tells Fred that Fred should have the operation that
night, or first thing in the morning.
Fred is prepped, to the extent of having marker pen arrows drawn on
him.

The surgeon turns up and says something along the lines of "You've done
this before, you'll do it again, there's no point giving you the
surgery" and chooses not to do the operation.

Fred is left with fingers or toes that he cannot move, and is
discharged from hospital with anti-biotics but no form of pain relief.

I'm interested in this because I've heard many smokers (in the nation
media) complaining about "rationing of health care", and there's been
some debate about whether it's ethical to deny some treatment to
alcoholics when other people in the lists might be "more deserving"
(not my words), but I haven't seen this debate extended to the area of
mental health.

I'm asking in a legal newsgroup because I'm especially interested to
hear about real life cases. I'm especially interested in cases that
resulted in a trust having to pay a patient for treatment denied, or in
cases where surgeons were 'disciplined' for denying treatment.

"bealoid" wrote:

I'm interested in this because I've heard many smokers (in the
nation media) complaining about "rationing of health care", and
there's been some debate about whether it's ethical to deny some
treatment to alcoholics when other people in the lists might be
"more deserving" (not my words), but I haven't seen this debate
extended to the area of mental health.

I don't think it's a matter of simply refusing to give care when
someone has contributed to his condition. But there is not an
unlimited budget for health care, and there are not an unlimited number
of organ donors. When resources are scarce and the doctors must make
choices, that is one way they make them.

From a legal standpoint you have to ask if this kind of discrimination
is made on a rational basis and not arbitrary. And while I don't
advocate withholding medical care from anyone in need, I think the
answer has to be yes, this kind of decision is rational, reasonable and
as a result legal.

Stu

Terry W. wrote:

But, of course, any surgeon (or any other doctor)
must take all possible actions to save the life of a person in his/her
care.

There is no such requirement. The doctor must exercise his clinical
judgement.

If that judgement is the patient is better off dead, there is no
requirement to act.

If that judgement is that some other patient would gain more benefit
from a limited resource, it is entirely reasonable to deny that resource
to a patient who would gain less benefit.

bealoid wrote:

I see that I haven't been clear enough, so here's an example:

Fred self harms.The A&E doctor tells Fred that Fred has caused
some damage that requires surgery.
snipped for brevity
The surgeon turns up and says something along the lines of "You've
done this before, you'll do it again, there's no point giving you the
surgery" and chooses not to do the operation.

OK - Here's another example :

Sharon gets a huge, ugly tattoo, but then goes to her doctor a few days
later asking for laser surgery, which is provided for her.. This happens a
few times, and it becomes evident that she is repeating a pattern.

The next time she does it, the surgeon turns up and says something along the
lines of "You've done this before, you'll do it again, there's no point
giving you the surgery" and chooses not to do the operation.

I think such cases must present doctors with very real dilemmas. Resources
and waiting lists are constrained, and treatment of a serial self-harmer
must be done at the expense of other patients who are also needy.

Whilst no-one would wish to see harsh criteria being applied, there must
come a point where a doctor's conscience & professional judgement lean
towards allocating the scarce treatment to another patient, because it will
provide a greater return in terms of quality of life & public good.

It would be interesting to know if such decisions have been reviewed or
challenged.

Steve Walker wrote:



Sharon gets a huge, ugly tattoo, but then goes to her doctor a few days
later asking for laser surgery, which is provided for her.. This happens a
few times, and it becomes evident that she is repeating a pattern.

The next time she does it, the surgeon turns up and says something along the
lines of "You've done this before, you'll do it again, there's no point
giving you the surgery" and chooses not to do the operation.

I think such cases must present doctors with very real dilemmas. Resources
and waiting lists are constrained, and treatment of a serial self-harmer
must be done at the expense of other patients who are also needy.

Whilst no-one would wish to see harsh criteria being applied, there must
come a point where a doctor's conscience & professional judgement lean
towards allocating the scarce treatment to another patient, because it will
provide a greater return in terms of quality of life & public good.

It would be interesting to know if such decisions have been reviewed or
challenged.

For the situation as described, in the UK it's very rare for any laser
tatoo removal to be funded by the NHS. I've certainly been involved with
turning down more applications than I can remember when I worked for a
Primary Care Trust. Occasionally people appealed - we never lost.