by Magda D. Healey

Created on: November 26, 2010

There are four fundamental reasons why smokers and the obese should not – and must not - be denied coronary artery bypass surgery, or for that matter any other medical procedure assuming the same procedure is available to non-smokers and non-obese.

The first one is to to with scientific facts and can be called a non-sequitur. Smoking and obesity are epidemiological risk factors, are correlated with heart disease, not causes of it. This is statistically speaking. Overall, people who smoke and people who are obese are more likely to develop heart disease, but this is by no means a 100% correlation: not all people with heart disease are obese or smoke(d), and not all smokers or obese have (or will end up having) heart disease. If we cannot prove causality on a mass scale, we cannot prove causality in any individual. We have no idea whether a certain smoker or an obese person who develops heart disease would have not developed it had he or she not smoked and stayed healthy weight, and thus we cannot assume that his conditions was self inflicted.

Frankly, this one reason is enough. Unless we accept that it's morally permissible to sentence people to punishment on the basis of probability of guilt rather than require the guilt proven beyond reasonable doubt, no other reason is needed.

The second reason can be called slippery slope. If we deny treatment to people whose conditions are (or may be, or are likely to be) self-inflicted, then when this will end? Presumably anybody suffering an accident while engaged in sport should be denied treatment too? And so should all those that suffer from skin cancer, if there is any indication that they exposed themselves to the sun at any time after they turned eighteen? What about anybody that is infected with sexually transmitted disease? Should we send away those who suffer from a heroine overdose or a delirium tremens? What about a woman beaten up by her husband who had done it before, but now she has broken arm, should she be sent away without help as she had not left him in time? Should we refuse treatment to those who visited malaria destinations but didn't take the anti-malarial drugs and caught the disease? The list is endless. In fact, in most cases of medical problems, and especially in degenerative conditions of the old age, but by no means only those, there are some correlates with the lifestyle, behaviour or actions of the individual. Some of these are much stronger connections than connections between obesity

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