Persaud R
Bethlem and Maudsley Hospitals Trust, London.
J Med Ethics. 1995 Oct;21(5):281-7. doi: 10.1136/jme.21.5.281.
The question whether rights to health care should be altered by smoking behaviour involves wideranging implications for all who indulge in hazardous behaviours, and involves complex economic utilitarian arguments. This paper examines current debate in the UK and suggest the major significance of the controversy has been ignored. That this discussion exists at all implies increasing division over the scope and purpose of a nationalised health service, bestowing health rights on all. When individuals bear the cost of their own health care, they appear to take responsibility for health implications of personal behaviour, but when the state bears the cost, moral obligations of the community and its doctors to care for those who do not value health are called into question. The debate has far-reaching implications as ethical problems of smokers' rights to health care are common to situations where health as a value comes into conflict with other values, such as pleasure or wealth.
医疗保健权利是否应因吸烟行为而改变,这一问题对所有沉溺于危险行为的人都有着广泛影响,且涉及复杂的经济功利主义论点。本文审视了英国当下的争论,并指出这场争议的主要意义已被忽视。这场讨论的存在本身就意味着,在全民医疗服务的范围和目的上,分歧在不断加大,全民医疗服务赋予了所有人健康权利。当个人承担自己的医疗费用时,他们似乎会为个人行为对健康的影响负责,但当国家承担费用时,社会及其医生照顾那些不重视健康之人的道德义务就会受到质疑。这场辩论有着深远影响,因为吸烟者医疗保健权利的伦理问题,在健康作为一种价值观与其他价值观(如愉悦或财富)发生冲突的情况下很常见。