April 25, 2006


Overeaters, smokers and drinkers: the doctor won't see you now: Health care is meant to be open to everyone equally. But some doctors question, even deny, treatment to those with certain vices. (NICHOLAS KOHLER AND BARBARA RIGHTON, 4/18/06, Maclean's)

At issue: health care for patients with self-destructive vices -- overeating, smoking, drinking or drugs. More and more doctors are turning them away or knocking them down their waiting lists -- whether patients know that's the reason or not. Frightening stories abound. GPs who won't take smokers as patients. Surgeons who demand obese patients lose weight before they'll operate, or tell them to find another doctor. Transplant teams who turn drinkers down flat. Doctors say their decisions make sense: why spend thousands of dollars on futile procedures? Or the decision is the product of frustration: why not make patients accountable for their vices? Others call it simple discrimination. But in a health system with more patients than doctors can treat, where doctors have discretion over whom they'll take on, some say it's inevitable that problem patients will get shunted aside in favour of healthier, less labour-intensive cases.

So here's the question: if people won't stop hurting themselves, can they really expect the same medical treatment as everyone else? Health care in Canada is supposed to be about equal treatment for all comers. For some doctors, however, there are patients who are less equal than others. Winnipeg GP Frederick Ross is one. In 2002, he told his patients he'd no longer see them if they continued smoking. "I said, this is stupid. I told my patients, you have three months to quit or I am going to ask you to find another doctor," recalls Ross, a genial man. "I said, your smoking is impeding my progress in treating you." Some people left in a huff. One challenged him on the basis of human rights (a tribunal later threw the case out). Others -- hundreds, he says -- stayed and quit smoking.

Cutting out the cigarettes might have helped some patients avoid an appointment with Dr. Alberto de la Rocha. As a former thoracic surgeon in Timmins, Ont., de la Rocha operated on lung cancer patients for 17 years before quitting. "I burned out in an atmosphere of indifference and lack of accountability -- public and personal accountability," says de la Rocha, who is now a medical officer of health in northeastern Ontario. Smoking, says de la Rocha, goes hand in hand with entitlement. "It goes like this: 'I am sick. You are the guy who is supposed to cure me. You are going to do that in whatever condition I am in and that is my right.' "

Not in my operating room, said de la Rocha, who decreed that his lung cancer patients would have to minimize their risks of a heart attack on the table or of post-op respiratory complications by not smoking for at least five weeks before surgery.

Obviously it makes even more sense where health care is rationed, but is good policy regardless.

Posted by Orrin Judd at April 25, 2006 12:34 PM

And let's not forget to deny care to those weird anti-social types who endanger themselves and all of us by neglecting to wash their hands in public washrooms.

Posted by: Peter B at April 25, 2006 1:36 PM

I think the doctors are right on in denying care to the irresponsible. Medicare and health insurance plans should do the same or at least impose additional fees for additional care when required.

As for the anti-social incosiderate pigs who neglect hand washing ... don't get me started.

Posted by: Genecis at April 25, 2006 2:09 PM

What used to be called personal hygiene would prevent a lot of disease. With the advent of antibiotics, we've gotten sloppy about washing our hands, covering our mouths, etc. I recently read that even the dread bird flu can be prevented by simply washing our hands with soap and water.

Perhaps a public health campaign should be initiated reminding us how simple hygiene can help keep us from getting sick.

Posted by: erp at April 25, 2006 2:17 PM


Really? Then I trust you would equally favour denying treatment to medical needs resulting from:

A)jogging over aged 35;
B)playing a sport without wearing the latest ASA approved equipment;
C)cosmetic surgery;
D)having sex without a condom;
F)engaging in any high-risk sports;
G)swimming alone or without life preservers;
H)driving over the speed limit;
I)failing to floss.

...etc, etc.

Posted by: Peter B at April 25, 2006 2:28 PM


Certainly insurance should be excused from covering such behaviors.

Posted by: oj at April 25, 2006 2:33 PM

J. Any STD. Recreational sex is after all unnecessary. You´re not married, you´re own your own.

K. Having no sex at all. This increases the likelyhood of a heart attack, so some guys are screwed either way. But that´s alright since they serve no purpose in the greater scheme of things!

What about people who damage their eyes reading blogs?

Posted by: wf at April 25, 2006 3:03 PM

k is lol funny.

Posted by: David Cohen at April 25, 2006 3:39 PM

If I were a physician I would want sick patients, as long as they had money. The sicker and richer, the better for business.

Posted by: Shelton at April 25, 2006 4:09 PM

What OJ said. Don't hand me the bill for negligence or stupidity.

Posted by: Genecis at April 26, 2006 5:39 PM


Then no doubt you will support our plan to install government bureaucratic committees in every hospital emergency room to assess whether the arrivals have lived their lives with sufficient care to merit medical attention. Some may be worried about bureaucratic fads, confusion, self-preservation and imcompetence, but we've taken care to implement the very latest in control procedures to prevent any of that nonsense. It's going to be different this time. We promise.

Although, I have to admit, as studies show the religious lead longer and healthier lives, it could be one heck of a prosletyzing tool. It sure would beat traipsing through the streets reading from Isaiah.

Posted by: Peter B at April 26, 2006 5:59 PM