Doctors back denial of treatment for smokers and the obese

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1 Key words
Fill the gaps in the sentences using these key words from the text. blackmail in-vitro rehabilitation slim down gluttony ethics obese arbitrary transplant blanket

1. 2. 3. 4. 5. 6. 7. 8. 9.

If someone is described as ____________________________, they are too fat, in a way that is dangerous for their health. If you ____________________________ someone, you use threats to persuade them to do what you want them to do. ____________________________ treatment is performed in a laboratory. A ____________________________ is a medical operation in which a new organ is put into someones body. If you ____________________________, you lose weight. ____________________________ is the process of returning to a healthy, independent and useful life after a serious illness or an operation. ____________________________ is the bad habit of eating much more than you need to eat. ____________________________ are a set of principles that people use to decide what is right and what is wrong. An ____________________________ decision is one that is not based on any particular plan or made for a particular reason.

10. A ____________________________ ban is one that affects or is aimed at everyone equally, even when this is not sensible or fair.

2 What do you think?

Decide whether these statements are true (T) or false (F). Then check your ideas in the text. 1. 2. 3. 4. 5. 6. Almost all doctors in the UK support a ban on medical treatment for smokers and the obese. In-vitro fertilization is less successful in women who smoke. In some parts of England, smokers and obese people cannot get hip and knee surgery. Giving up nicotine guarantees that an operation will be a success. Operating on obese people is more dangerous than operating on people whose weight is normal. The only reason that people are obese is gluttony.

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Doctors back denial of treatment for smokers and the obese

Level 3

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6 One PCT decided to withhold hip and knee surgery from obese patients until they had slimmed down by 10% or had a body mass index of under 35. Another obliged obese people to lose 5% of their body weight and keep the pounds shed for at least six months before receiving treatment. 7 But Dr Clare Gerada, Chair of the Royal College of General Practitioners, said the survey findings and trend towards lifestyle rationing was very disturbing. She said: Its the deserving and undeserving sick idea. The NHS should deliver care according to need. There was no medical justification for such restrictions on smokers, as giving up nicotine would not necessarily enhance an operations chances of success. Clearly, giving up smoking is a good thing. But blackmailing people by telling them that they have to give up isnt what doctors should be doing. Doctors should not back such bans unless there was overwhelming evidence that stopping smoking reduces the patients risk of suffering complications or dying, she added. 8 But obesity could merit such bans, Gerada said. Obesity is a different matter. Operating on a very fat person is more dangerous. Anaesthetically its harder, the surgery is harder and the rehabilitation takes longer. So its medically legitimate to withhold treatment from some very overweight people. But it should not be done for social reasons, she said. 9 Tam Fry, Spokesman for the National Obesity Forum, said doctors who back bans are totally out of order. Theres no way that someone who is obese can be denied initial treatment by the NHS that would be totally unjustified. There are many reasons why people are fat and gluttony is only one of them. The NHS should not be discriminating against fat people purely on the grounds of their fatness. That would be a denial of their basic human rights. 10 The Royal College of Physicians, which represents hospital doctors, said it opposed the practice. Lifestyle rationing is creeping into the NHS. There are reported examples where treatments have been restricted by PCTs and we wouldnt agree with that, said Professor John Saunders, Chair of the colleges ethics committees. But he defended doctors rights to examine whether a patients lifestyle might reduce the chances of a treatment
N T O FR BE C O DO O M W P W N IA EB LO B SI A L TE DE E D

Doctors back denial of treatment for smokers and the obese

Denis Campbell 29 April, 2012 1 A majority of UK doctors supports measures to deny treatment to smokers and the obese, according to a survey that has sparked a row over the National Health Services growing use of lifestyle rationing. 2 Some 54% of doctors who took part said the NHS should have the right to withhold non-emergency treatment from patients who do not lose weight or stop smoking. Some medics believe unhealthy behaviour can make procedures less likely to work, and that the service is not obliged to devote scarce resources to them. However, senior doctors and patient groups have expressed their alarm at what they call blackmailing of the sick, and denial of their human rights. 3 Doctors.net.uk, a professional networking site, found that 593 (54%) of the 1,096 doctors who took part in the self-selecting survey answered yes when asked: Should the NHS be allowed to refuse non-emergency treatments to patients unless they lose weight or stop smoking? One doctor said that denying in-vitro fertilization to childless women who smoked was justified because it was only half as successful for them. Another said the NHS was right to expect an obese patient or alcoholic to change their behaviour before they underwent liver transplant surgery. 4 Dr Tim Ringrose, Doctors.net.uks Chief Executive, said the findings represented a significant shift in doctors thinking brought on by the NHS in Englands need to save 20 billion by 2015. This might appear to be only a slim majority of doctors in favour of limiting treatment to some patients who fail to look after themselves, but it represents a major shift for a profession that has always sought to provide free healthcare from the cradle to the grave, he said. 5 Smokers and obese people are already being denied operations such as IVF, breast reconstructions and a new hip or knee in some parts of England. The medical magazine Pulse last month found that 25 of 91 primary care trusts (PCTs) had introduced treatment bans for those groups since April 2011.

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Doctors back denial of treatment for smokers and the obese

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weight or stopping smoking before surgery because the risk of surgery can become greater. 12 Dr Mark Porter, Chairman of the British Medical Associations consultants committee, said treatment bans were wholly unacceptable. But he added: There are occasions where a doctor may advise an obese person to lose weight before surgery can safely go ahead. This is a clinical rather than a rationing decision. Dr Ringrose said: Perhaps its time for the NHS to have a realistic discussion with UK taxpayers about what treatments it can continue to cover.
Guardian News and Media 2012 First published in The Observer, 29/04/12

succeeding. Some lifestyles will impact on the success of treatments; for example, if someone weighs 150 kilograms, that may have an impact on the outcome. Lifestyles contribute to risk and sometimes they may make treatments too risky to undertake. But thats quite different from saying, Im not going to give you surgery because you smoke or are overweight, said Saunders. 11 The Department of Health took a similar stance. There is no excuse to deny care on the basis of arbitrary blanket bans the individual needs of patients must be taken into account, said a spokeswoman. But there can be clinical reasons to ask someone to take action such as losing

3 Comprehension check
Choose the best answer according to the text. 1. a. b. c. 2. a. b. c. 3. a. b. c. 4. a. b. c. Why do some doctors believe the health service should have the right to deny treatment to the obese and people who smoke? because they want to force people to change their behaviour because unhealthy behaviour can reduce the chances of medical procedures being successful because they want obese people to keep their weight down for six months before treatment Why has the shift in thinking occurred? because the NHS needs to save money and some doctors feel such patients are a waste of scarce resources because the number of obese people and smokers is growing because doctors are becoming increasingly aware of the need for lifestyle rationing Why do some doctors argue that it is medically legitimate to withhold treatment from obese people? because they think it should be done for social reasons because it is more complicated to operate on obese people because giving up nicotine does not make any difference to the success of an operation Why do many doctors oppose restrictions on treating obese people and smokers? because they argue that the individual needs of patients must be taken into account and that it is wrong to impose blanket bans because many of their patients are obese and smoke and they would lose money as a result because lifestyles have no impact on the success of treatments

Macmillan Publishers Ltd 2012 NEWS LESSONS / Doctors back denial of treatment for smokers and the obese / Advanced

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Doctors back denial of treatment for smokers and the obese

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4 Find the word

Find the following words and phrases in the text. 1. 2. 3. 4. 5. 6. 7. 8. a three-word expression meaning cause an argument (para 1) a three-word expression meaning only a little more than half (para 4) a six-word expression meaning through your whole life (para 4) a verb meaning to deliberately not give something to someone (para 6) a three-word expression meaning a measurement of the amount of fat in someones body, calculated by dividing their weight in kilograms by their height in metres squared (para 6) a verb meaning to improve (para 7) a four-word expression meaning as a result of (para 9) a three-word expression meaning adopt a certain attitude (para 11)

5 Verb + noun collocations

Match the verbs in the left-hand column with the nouns or noun phrases in the right-hand column. 1. 2. 3. 4. 5. 6. withhold undergo devote reduce impact on defend a. b. c. d. e. f. the success of something someones right to something surgery treatment the risk resources to something

6 Word-building
Complete the sentences using the correct form of the word in brackets at the end of each sentence. 1. 2. 3. 4. 5. 6. _____________________ is a major problem for the health service. [OBESE] The trend towards lifestyle rationing has been described as _____________________. [DISTURB] Stopping smoking may reduce the risk of _____________________ during or after an operation. [COMPLICATE] One doctor said that treatment bans were completely _____________________. [ACCEPT] There is no medical _____________________ for restrictions on smokers. [JUSTIFY] Discriminating against fat people would be a _____________________ of their basic human rights. [DENY]

7 Discussion
Should people who dont smoke and have healthy lifestyles be expected to contribute through their taxes to the medical treatment of people who smoke and are obese? Why? Why not?

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Doctors back denial of treatment for smokers and the obese

Level 3 KEY

Advanced

1 Key words
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. obese blackmail in-vitro transplant slim down rehabilitation gluttony ethics arbitrary blanket

5 Verb + noun collocations

1. 2. 3. 4. 5. 6. d c f e a b

6 Word-building
1. 2. 3. 4. 5. 6. obesity disturbing complications unacceptable justification denial

2 What do you think?

1. 2. 3. 4. 5. 6. F T T F T F

3 Comprehension check
1. 2. 3. 4. b a b a

4 Find the word

1. 2. 3. 4. 5. 6. 7. 8. spark a row a slim majority from the cradle to the grave withhold body mass index enhance on the grounds of take a stance

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NEWS LESSONS / Doctors back denial of treatment for smokers and the obese / Advanced

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