Should the NHS pay for operations for people with diseases caused by unhealthy lifestyles?

This is a difficult question because practical considerations are overshadowed by ethical dilemmas. The big problem the NHS has with providing funding for operations of any kind is that their resources are finite. The present UK government will always argue that they are commited to this public service in terms of honouring financial commitments, but this is open to question. Medical staff and administrators are arguing that budgets are not matching the strain being placed on the service by the increasing numbers of the population who may be living longer, but are presenting the NHS with an ever expanding workload.

Clinical staff are being asked to make a judgement about the value of one person's life over another, when their professional career is dedicated to treating illness, regardless of how it arose. Against this backdrop, who is qualified to decide whether or not an obese person or a chainsmoker must go to the back of the treatment queue? Overeating is often a symptom of an underlying mental issue, although someone simply regarded as being overweight will never be treated as sympathetically as an anorexic. If nicotine addicts are to be denied care, then what about any other drug addiction, like prescription pills? The groups working to combat the scourge of heroin abuse in society will take exception to criteria being placed on whether or not a patient's wellbeing is being ranked according to some moral code.

Doctors and hospital managers do have to allow a certain amount of administrative practicalities to enter decision-making; again, down to those finite resources. Where patients have repeatedly refused to obey their doctor's advice about cutting out cigarettes, given the proven risk of heart disease, strokes and lung or mouth cancer, then the ethical argument becomes more ambiguous. These individuals are perhaps fortunate that they are living in times when the issue is being debated. If the NHS continues down the path of being underfunded, the eroding of pay and conditions leading to recruitment shortages, and privatisation undermining its central ethos, then the same question might become far more black and white in future. Patients might be faced with ultimatums rather than advice.