Margaret McCartney: The government’s plan to blame and shame people for having disease
BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4368 (Published 17 August 2015) Cite this as: BMJ 2015;351:h4368
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Dear editor,
The confidence of McCarthy in "our regulators, such as the General Medical Council, not to coerce people into treatment" seems misplaced. (1)
The GMC has been using their regulatory powers to coerce doctors to have ineffective medical treatment for a minor self limiting disease (influenza vaccination) for which most do not have a clinical indication. (2) Worse, at the same time we are denying vaccination to patients who are in the same position (outside the at risk categories). How unethical can you get?
The response of Lewis does not refer to the case of Mr Condiff, a prime example of how access to care is arbitrarily and inequitable affecting those with potentially embarrassing conditions that McCartney is referring to. (3, 4)
The mushrooming of inequity and postcode lotteries through 'low priority lists', 'not routinely funded', or other euphemisms for restrictive practice should be a concern for anyone that cannot afford to access care privately. The problem is not limited to the NHS. (5)
(1)McCartney. The government’s plan to blame and shame people for having disease. BMJ 2015;351:h4368. http://www.bmj.com/content/351/bmj.h4368
(2) http://www.gmc-uk.org/GMC_News___February_2014.pdf_54928597.pdf
(3) Lewis. Reply to Susanne Stevens. http://www.bmj.com/content/351/bmj.h4368/rapid-responses
(4) Sokol. Bariatric surgery and justice in an imperfect world. BMJ 2011;343:d4944. http://www.bmj.com/content/343/bmj.d4944
(5) http://www.medscape.com/viewarticle/848249_3?nlid=85343_430
Competing interests: No competing interests
I read Susanne Stevens response with mounting alarm ... is it really the case ?
"They get away with it because those who are suffering from stigmatised conditions have to be investigated, placed under surveillance and accept degrading behaviour in order to survive."
I simply do not recognise this as reality. Can Susanne quote an example case ?
"The well off can avoid this by for example, paying privately for medical attention. Somebody who needs subsistence cannot just see a medic for medical help but needs evidence and confirmation passed to the state."
NHS patients are accorded precisely the same confidentiality as private patients, policed by the GMC. The rules applying to 'state subsistence allowance' are entirely separate and apply equally to all applicants.
"The concept of a confidential consultation has been withered away for those without finances enough to avoid state intrusion."
vide supra. Every patient, public or private, is entitled to confidentiality within GMC guidelines. Patients seeking State benefits are subject quite separately to State legislation.
"A few of the very older generation can still recount how welfare officers would police lives to the extent of prying into the items of furniture a claimant possessed - hardly any different from the anger stirred up by some against people claiming Independent Living Allowances."
The memories and anger are no doubt real in many cases, but would Susanne wish State welfare support to paid to all claimants unchecked ?
"Seems we are going backwards to the days of the shameful grovelling required from the 'undeserving poor' of Victorian times. Maybe we will see a version of the poorhouse introduced soon. An item on R4 News today described a new proposal being considered by the government and described as a 'boot camp' for 18 year old claimants who will be ordered to join another scheme designed to get them work ready. Those with parents and their friends in useful positions will grow up never experiencing this sort of outrage yet some will become the next generation of politicians and other professionals who set up hoops for others to jump through."
All these threats remain in prospect, not yet reality, surely ? Should we be more clear - State benefits are decided by the democratic process through Law, entitlement determined by due process, and payment made according to assessed entitlement. Not everyone likes the government policy, least of all me. But there are democratic mechanisms for appeal, individually or en masse.
Competing interests: No competing interests
They get away with it because those who are suffering from stigmatised conditions have to be investigated, placed under surveillance and accept degrading behaviour in order to survive. The well off can avoid this by for example, paying privately for medical attention. Somebody who needs subsistence cannot just see a medic for medical help but needs evidence and confirmation passed to the state. The concept of a confidential consultation has been withered away for those without finances enough to avoid state intrusion. A few of the very older generation can still recount how welfare officers would police lives to the extent of prying into the items of furniture a claimant possessed - hardly any different from the anger stirred up by some against people claiming Independent Living Allowances. Seems we are going backwards to the days of the shameful grovelling required from the 'undeserving poor' of Victorian times. Maybe we will see a version of the poorhouse introduced soon. An item on R4 News today described a new proposal being considered by the government and described as a 'boot camp' for 18 year old claimants who will be ordered to join another scheme designed to get them work ready. Those with parents and their friends in useful positions will grow up never experiencing this sort of outrage yet some will become the next generation of politicians and other professionals who set up hoops for others to jump through.
Competing interests: No competing interests
Margaret raises important issues, and seems to be against naming and shaming. But her reasoning leaves me confused. Surely everyone is against "coercing [anyone] to accept ineffective medicine". But is she in favour if it were effective ? Is her objection simply that trials have not been done ?
My own view is that people, even criminals in gaol, are entitled to food shelter and clothing. I would give beggars and drug addicts food shelter and clothing. But I would baulk at giving them money for them to spend on drugs or alcohol. I believe this position is ethically distinct from punishing or shaming people for unhealthy choices, or blaming them for the mess they are in. It aims to help without harming.
Competing interests: No competing interests
Re: Hendrik Beerstecher's 'Cundiff' case
I thank Hendrik for bringing the case to my attention. Others may be interested in forming their own ethical and moral and legal judgements upon it.
see http://www.mills-reeve.com/files/Publication/62f86fb6-8ad1-4df3-8102-b39...
It should be noted that Staffordhire HA after several legal challenges eventually approved funding on grounds of 'exceptionality'. Or was it ?
see http://www.bmj.com/content/343/bmj.d4944/rapid-responses
Competing interests: No competing interests