1、1A Question of ResponsibilityAcolleague recently suggested to me that Orientalmedicine is largely preventative,while Westernmedicine is generally curative.I tested this thesisby visiting my local nharmacy in England,wherethere was no doubt that most of the products on sale weredesigned to fix your p
2、roblems,rather than to stop them oe-eurring in the first place. Does this suggest different attitudes between East and West,or is it merely a reflection of what happens in a more highlydeveloped healthcare system,such as we have in the UK? Cer-tainly,there is an attitudinal problem in my home countr
3、y,where there is a high level of expectation that the governmentshould provide a healthcare service that is both complete andof the highest possible quality. This begs three questions: first,what about personal re-sponsibility for ones own health? Second,what exactly shoulda complete health service
4、include? And third,who is going topay for it? As reg.ards responsibility,if we accept that every humanhas a right to life,is that the same thing as a right to health? 2Ifso,does it mean that the health of every individual becomes asocietal obligation,rather than something for which the indi-vidual s
5、hould accept primary responsibility? In every country,perhaps worst of all in the USA,we seeevidenea of people who eat,drink,or smoke indiscriminately,and suffer from serious health problems as a result,l havealways held the view that we are what we eat,so our dietaryhabits define the health of our
6、bodies.Should we then pun-ish those who eat too many hamburgers? Is it acceptable thatsuch people still feel entitled to rety on the public healthearesystem when they fall ill? Is it possible or even desirable todraw a distinction between people who have been “well be-haved“ and those who havent? An
7、d anyway,how do we definemoderation? At what point does drinking red wine becomedangerous to the body? (As an aside,I note that,during Napo-leonic times,the French designated the red wine of St Chinianas being officially approved for consumption in hospitals onthe basis that it enhanced blood count
8、and iron content in thesystem). Let us now propose for a moment the establishment of anational healtheare system in each country in the word.Whatsort of thing should that system include? I suspect 3that it isindisputable that mental healtheare would be very high on theagenda of most countries,party
9、because private families havelittle idea how to manage mentally ill relatives.They requireprofessional assistance,which argues for having a service withspecific expertise in this area. But where does it all end? Many people would say that na-tional health services should make provision only for a ba
10、siclevel of healthcare,but this quite possibly does not take intoaccount the increasing incidence of serious diseases requiringmajor surgery or long hospital stays.And should the publicpurse be asked to fund treatments that make people feel better about themselves? Perhaps it is obvious that someone
11、 who hassuffered severe burns should be entitled to plastic surgery torepair visible damage,but does the same apply to facial defor-mities? And what about a compulsive eater whose vice can becured with a gastric band? Do such things count as psychologi-cal healthcare? In the UK health service,the an
12、swer is often.“yes!“ And to what extent should health services pay for “alterna-tive“ medicines? This is the subject of much debate,becausepractices such as acupuncture are not viewed as conventionalin the West,but are very much part of the 4traditional medi-cal scene in the Orient.Only last week,a
13、friend in Beijing wastelling me how his back spasm had been cured in a matter ofminutes through acupuncture therapy applied to his hands - atreatment that would have received little credence back homein England. Perhaps the most emotive question in the West is about ex-pensive new drugs that have th
14、e potential either to eliminatecancers or to prolong life.In this ease,the issue is whethersuch drugs should be made available without regard to costand whether they should be entirely free to the patient.Manywould say that income taxes are specifically intended to coversuch things,while others (suc
15、h as the French) would argue thatthe patient should bear a portion of the cost of all healtheare. So perhaps we have come to the question of affordability.How long should a comatose patient be allowed to remain ona ventilator in a hospital? Should patients bear part of the costof treatment? The answ
16、ers to these questions are very subjec-tive,so maybe what we need is a decision-making structurethat brings a greater degree of objectivity to the problem.Bjorn Lomborg,in his book Solutions for the Worlds Big-gest Problems (Cambridge University Press,2007) 5suggeststhat choices based on economic fa
17、ctors may be the logical ap-proach.He advocates “economic cost-benefit analysis to pro-vide a coherent framework for evaluation.“ Deciding betweenvery different options is not easy,but,as Lomborg says,“Wehave to make choices.Not prioritizing explicitly means westill make choices,we just dont talk as
18、 clearly about them.Ibelieve that putting prices on the worlds solutions makes ourdecisions better informed.“ Universal healtheare is an alarmingly expensive proposition,which is why the American Republicans argue against it.Butsurely every nation deserves to have something.If citizens arewilling to acknowledge that they have a responsibility for theirown well-being,society should be prepared to build a healthyenvironment and to contribute to their healtheare.The onlyquestion,I believe,is: “How much? “
