Getting cigarettes on a doctor's prescription

[Captain Seafort]

Anyways... you missed the point or I wasn't clear: I wasn't saying that after those 4 things the next logical step would be the one regarding intellect. All I had in mind is that once you start deciding that some don't deserve medical treatment you risk going down a slippery path. Once one thing is widely accepted, it's not hard to imagine this kind of logic being applied: if A doesn't deserve treatment and B is so similar to A, maybe B shouldn't get treatment either. If this new rule is accepted too, then someone will notice that C isn't all that different from B... so why should they get treatment? And so on...

This is a slippery slope fallacy. In order to argue this point you must demonstrate that A will lead to B and B to C, and so on, not merely state that "it might happen".

What about someone who smokes occasionally (social smoking); is that as bad as someone who smokes 2 packs a day? Do they deserve treatment or not?

The Swedish model is clearly aimed at habitual smokers - not those who've bummed a fag off their mates once in a blue moon.

What about drinking? a beer once or twice a week is ok, or should I be left to die for it?

As I said above, those who regularly exceed the recommended daily limit.

Wasn't there an episode in TNG, Justice I think, where the point was the law shouldn't deal in absolutes?

The law not only should, but must deal in absolutes. You are either guilty or not guilty - there's no halfway house.

[Lighthawk]

Some people have survived being shot in the head, with no medium or long-term ill effects. Therefore being shot in the head poses only a low risk to an individual's health.

Cute, but actually that only furthers the point. No one, NO ONE, knows for certain just how long anyone else has to live. Even the most statistically unlikely cases have their survivors. Which is why when someone comes into a hospital all shot full of holes, the doctor doesn't say "Well his odds of survival are so low, its not even worth trying." When it comes to human lives, it is not acceptable to just give up on them because of the odds, not for anyone in the medical field. I don't care if a person smokes ten packs a day, downs ten beers before breakfast, and likes to play Russian Roulette, it is not the place for a doctor to judge that individual's worthiness for medical treatment.

If that lifestyle choice has a direct and serious impact on their health, and they demonstrate no intention of modifying said behaviour, then absolutely.

Well then there is little more to say here, other than I disagree with your opinion in the extreme.

The two are linked. Since the smoking is significantly reducing the effectiveness of the treatment, the cost-effectiveness of the treatment is likewise much reduced. Since these are people's taxes being spent on said treatment, why should the state cough up to help someone who evidently doesn't want to help themselves. Note that this isn't a case of "you've been a smoker, therefore we won't treat you", it's "you are a smoker and won't stop, therefore we won't treat you."

Well 1st off, if the person has access to state provided health care, he's been putting his share of his taxes into it as well, I see no reason he shouldn't be able to get back on the money he's put in.

More to the point though, it's not about the money. If you want to argue about whether a smoker who won't quit should or should not be able to get the state to pay for his treatment, I'd be less inclined to disagree and might be willing to consider the logic.

What I am more going on about is the idea of doctors being able to flat out refuse to provide medical care to a person based on their life style choice. Bill the smoker in full if needed, but they should still be able to receive whatever treatment they require, regardless of however detrimental their lifestyle is to their health.

[Giuseppe]

This is a slippery slope fallacy. In order to argue this point you must demonstrate that A will lead to B and B to C, and so on, not merely state that "it might happen".

I do not care to demonstrate anything. If you disagree with what I said, it's fine by me; it's not as if I'm trialing for the debate team. I could start explaining various things, I might give examples, I doubt it would accomplish anything. The bottom line is that I firmly believe that there is no moral justification for withholding someone's medical care, unless that person so wishes. I'm sure it's also in line with the moral values of any doctor I'd ever care to have treating me. It's also probably part of the oath most doctors have to swear by when they finish medical school.

Now if you'll excuse I will enjoy the day's last cigarette. It's also the first

[Mikey]

Then I suggest you see an optician, pronto.

Oh, stop, my sides can't take it. Unfortunately, your attempt at deflective humor doesn't make your arbitrary divisions any less so.

Once again, while there is a risk of damage to the body while participating in physical sports (which would include conditions that developed subsequently), damage to the body due to smoking or excessive drinking is not a risk, it is a certainty.

And, once again, this fact is completely meaningless to the discussion at hand. If the footballer has either of the ailments I described, the ailment is a direct result of his career choice. I'm even giving you the benefit of the doubt in describing an ailment that results from the lifestyle choice, unlike the Swedish doctors. In any event, the degree of increase of risk is immaterial - we're hypothetically talking about an ailment that is directly resultant from said lifestyle choice. So, I'll ask again: the footballer's injury is a direct result of his choice to engage in a behavior that caused the injury whereas a different choice wouldn't have. So why should he be treated for it if a smoker shouldn't be treated for an ailment that doesn't result from smoking or has recovery impaired by smoking?

Utterly irrelevant to the point.

So, now anything which counters your point is "irrelevant?" You made the claim that my Tay-Sachs example was invalid due to the sufferer being incapable of choice in the matter. The fact of the sufferer being unable to make any decisions because of his state of infancy, and the decision to have a child while higher risk factors are present being the choice of the parents, counters that claim. What's being discussed here is a medical community's refusal to do their job because of people's decisions to engage in high-risk behavior. What I have described here is alternate situations in which the medical community could also apply that "logic," in the hopes of showing how ridiculous it sounds when applied to situations that don't offend a personal sensibility like smoking does. The fact that you are arguing to exclude my Tay-Sachs example only illustrates my point.

Which is related to decisions made by the individual requiring treatment...how, exactly?

See above. Your continued attempts to show lack of decision by an individual incapable of making a decision are both laughable, and getting annoying.

Baby step. Right. Just like the minute baby step in warfare from throwing a rock to throwing a thermonuclear-tipped ICBM.

No, not like that. Like a baby step. If you want to attribute implications which aren't present in order to try and discredit my point, I suggest you try to do it less obviously. However, as I mentioned above, we are discussing what would follow in the minds of a medical community which would refuse to do its job because of an offended sensibility or - worse - because their job might be more difficult than in another case. In this paradigm of discussion, it's exceedingly easy to envision someone making the "baby step" I described. Your hyperbole without point doesn't change that.

[Captain Seafort]

Cute, but actually that only furthers the point.

On the contrary, it's completely irrelevant to the point because it's just an anecdote. The plural of anecdote is not data. They can be used to illustrate points, but they cannot be used to refute scientifically proven facts.

When it comes to human lives, it is not acceptable to just give up on them because of the odds, not for anyone in the medical field. I don't care if a person smokes ten packs a day, downs ten beers before breakfast, and likes to play Russian Roulette, it is not the place for a doctor to judge that individual's worthiness for medical treatment.

I'm not proposing that any doctor do so, and neither do the Swedes. The decision would be made at the political level.

Well 1st off, if the person has access to state provided health care, he's been putting his share of his taxes into it as well, I see no reason he shouldn't be able to get back on the money he's put in.

The problem with that logic is that it's not just his money - it's everybody else's as well. An individual's taxes of a few grand a year would be nowhere near sufficient to pay for their own health care.

If you want to argue about whether a smoker who won't quit should or should not be able to get the state to pay for his treatment, I'd be less inclined to disagree and might be willing to consider the logic.

That's precisely what I am arguing.

[Captain Seafort]

And, once again, this fact is completely meaningless to the discussion at hand.

On the contrary, it's central to the discussion, for reasons I've already explained.

So, I'll ask again: the footballer's injury is a direct result of his choice to engage in a behavior that caused the injury whereas a different choice wouldn't have. So why should he be treated for it if a smoker shouldn't be treated for an ailment that doesn't result from smoking or has recovery impaired by smoking?

Because the development of the footballer's injury is merely a risk of playing that sport. That smoking damages the health of those who indulge in it is not merely a risk but a certainty. I've explained this once already.

You made the claim that my Tay-Sachs example was invalid due to the sufferer being incapable of choice in the matter. The fact of the sufferer being unable to make any decisions because of his state of infancy, and the decision to have a child while higher risk factors are present being the choice of the parents, counters that claim.

It does nothing of the sort. In the case of the smoker the choice was bade by the individual requiring treatment. In the case of Tay-Sachs the choice was not made by the individual requiring treatment. The two cases are utterly dissimilar.

Your continued attempts to show lack of decision by an individual incapable of making a decision are both laughable, and getting annoying.

So, your argument is that an individual who was in no way involved in making a given decision should be held responsible for that decision.

[Mikey]

No, I will remind you once again that my argument refers to the topic of this discussion - which is how people like the Swedish medical community can use the same logic to make the step from the smoking scenario to one like the Tay-Sachs example. In that case, the parents are responsible for both the decision-making and the medical care. Ergo, your attempts to dismiss it are merely a shroud to avoid saying "no" in once case and "yes" in another for nothing more than an arbitrary differentiation.

As to the footballer example, you can keep citing the difference between "risk" and "certainty," but those difference will keep being immaterial for that hypothetical situation. In that situation, the degree of increased risk from engaging in an assumed-risk behavior is meaningless; our hypothetical athlete HAS a sports-related injury, therefore the chances of having one are 100%. Just answer, rather than dodge: should he likewise be denied treatment because his injury stems from a lifestyle choice?

[Captain Seafort]

No, I will remind you once again that my argument refers to the topic of this discussion - which is how people like the Swedish medical community can use the same logic to make the step from the smoking scenario to one like the Tay-Sachs example.

No, they can't, because the logic involved is utterly dissimilar. One involves withholding treatment due to an individual's ongoing choice to damage their health, the other involves withholding treatment due to a choice two different people made years before. If you're too fucking stupid to understand the difference between these two situations then fuck off and stop polluting this thread with your idiocy.

As to the footballer example, you can keep citing the difference between "risk" and "certainty," but those difference will keep being immaterial for that hypothetical situation.

On the contrary, it's central to the argument - in the case of the football, at the time he made the decision to play the sport he would have been aware that there was a risk that it could damage his body, but this was by no means a certainty. In the case of the smoker, they would at some point (for an increasing percentage this will be before they started) have become aware that his actions were certain to damage his body. If the football was at some point told that he was suffering from the early stages of osteoarthritis, advised to stop playing to avoid exacerbating the problem, and he continued playing regardless, then the situations would be comparable, and a comparable solution should be enforced - refusal to treat the problem until he stops making it worse.

[Mikey]

No, they can't, because the logic involved is utterly dissimilar. One involves withholding treatment due to an individual's ongoing choice to damage their health, the other involves withholding treatment due to a choice two different people made years before. If you're too fucking stupid to understand the difference between these two situations then fuck off and stop polluting this thread with your idiocy.

Of course they could, in much the same way as the initial conclusion which began this part of the discussion. My stupidity isn't at question; but if you are too fucking evasive and unwilling to answer the question instead of throwing up completely false reasons why you shouldn't, then likewise bugger off.

Your confusion stems from there being an actual difference in the two situations (which there is, of course) and what's really at stake here: how people can force their perception in order to treat them in the same way. You keep arguing the former point, which is great but doesn't really matter here.

On the contrary, it's central to the argument - in the case of the football, at the time he made the decision to play the sport he would have been aware that there was a risk that it could damage his body, but this was by no means a certainty. In the case of the smoker, they would at some point (for an increasing percentage this will be before they started) have become aware that his actions were certain to damage his body. If the football was at some point told that he was suffering from the early stages of osteoarthritis, advised to stop playing to avoid exacerbating the problem, and he continued playing regardless, then the situations would be comparable, and a comparable solution should be enforced - refusal to treat the problem until he stops making it worse.

In order for this differentiation to be anything other than arbitrary, the soccer player would have had to have been completely unaware that his risk of sports-related injury would be higher than that of, say, a tax accountant. Well, then, if you're still so keen on degrees of risk rather than risk vs. no risk, why not grade the level of care? Said accountant gets a premium level care; footballer gets lesser care, because he willfully participates in a higher-risk activity; skydivers get even less care, etc., etc.

This also follows from your "logic," but do you see how ridiculous it sounds?

I've got another question for you: please briefly describe your last three meals (trust me, I'm going somewhere with this.)

[Captain Seafort]

Of course they could, in much the same way as the initial conclusion which began this part of the discussion.

The initial argument was against those who were continuously damaging their health and refusing to stop doing so. How is this in any way similar to a chronic, genetic condition, which the individual has no control over either the origin or continuation of? The logic is fundamentally different.

Your confusion stems from there being an actual difference in the two situations (which there is, of course) and what's really at stake here: how people can force their perception in order to treat them in the same way. You keep arguing the former point, which is great but doesn't really matter here.

Of course it matters. The issue at hand is whether the Swedish refusal to treat smokers unless they quit is justified. The various slippery slope fallacies people have been chucking out are utterly irrelevant to this argument.

if you're still so keen on degrees of risk rather than risk vs. no risk

Are you blind as well as stupid? I've been specifically arguing that it is a case of risk vs no risk (or in this case certainty, which is the same thing in terms of it being an integer level of risk).

I've got another question for you: please briefly describe your last three meals (trust me, I'm going somewhere with this.)

Cheese and crackers
Chilli con carne with rice
Sandwiches and veg

Not a perfect diet, certainly, but you're missing the key point that the Swedes are not saying "you've smoked during your life, ergo no treatment", they're saying "you are a smoker, ergo no treatment until you quit".

[Mikey]

Hmm. You are willingly party to a diet which is well-known for promoting atherosclerosis, coronary events, DVT, plaque (leading to stroke and necrosis including heart attack,) even forced mitral valve prolapse and essential hypertension. By the logic of the Swedish dictates, then, not only should you be denied treatment for heart disease... you should be denied treatment for a skin lesion or a bacterial infection until you become a vegan.

See how ridiculous it sounds when you study it rather than approach it from the standpoint of vindictiveness against smokers?

[Captain Seafort]

*sigh*

You're missing the key point that the Swedes are not saying "you've smoked during your life, ergo no treatment", they're saying "you are a smoker, ergo no treatment until you quit".

[Mikey]

Yeah, I get it. That's why I worded my last hypothetical exactly the way I did. Since you'd rather rant than read, I will repeat:

Hmm. You are willingly party to a diet which is well-known for promoting atherosclerosis, coronary events, DVT, plaque (leading to stroke and necrosis including heart attack,) even forced mitral valve prolapse and essential hypertension. By the logic of the Swedish dictates, then, not only should you be denied treatment for heart disease... you should be denied treatment for a skin lesion or a bacterial infection until you become a vegan.

The key words, which take into account exactly about what you've just screamed, are enlarged for your benefit.

*EDIT* BTW, exactly what sort of doctor would sit by and withhold lifesaving therapy from a patient, no matter the cause of the ailment? Not the sort of person who takes their oath or their commitment very seriously, I'd say.

[Captain Seafort]

The key words, which take into account exactly about what you've just screamed

No, they don't. Quitting smoking involves moving to a healthier lifestyle, not a grossly unhealthy one. If, on the other hand, a doctor advised me to change my diet, with recommendations of specifics, fair enough.

*EDIT* BTW, exactly what sort of doctor would sit by and withhold lifesaving therapy from a patient, no matter the cause of the ailment? Not the sort of person who takes their oath or their commitment very seriously, I'd say.

Hence why the doctors are removed from the decision-making loop.

[Tsukiyumi]

Just thought I'd chime in on this:

Hence why the doctors are removed from the decision-making loop.

Having politicians make medical decisions is about as intelligent as having plumbers make military decisions.