Healthcare, Ethics, & Postmodernism | Philosophy Tube

Healthcare, Ethics, & Postmodernism | Philosophy Tube


Hey As you can probably tell, I’m
not feeling so good, so I’m going to be doing most of today’s episode from
right here. I’ve got my Lemsip, I’ve got my chimpanzee – let’s talk about healthcare. PART 1 – Personal Responsibility In the my country the UK we have free healthcare – at time of recording, unless you’re one of the several million people for whom it isn’t actually free – and every now and again there’s a story in the news about some medical group restricting the care they provide to
patients who are very fat or who smoke. There was a famous one a few years ago: the Vale of
York Clinical Commissioning Group said that patients who have BMIs over 30 or who smoke will have to either lose weight or quit smoking before they can undergo elective surgery, and Clare Fogues writing the Times recently said that we need to start thinking about “deserving and undeserving patients.” One of the principles behind ideas like this
is that people who are in some way “responsible for their own bad condition” should be denied the healthcare they need,
or deprioritised for the healthcare they need, as “the best way of achieving maximum value from limited resources.” The result being that they would have to live longer with suffering that could otherwise be alleviated more quickly. When it comes to who should get healthcare, the classic examples philosophers like to talk about are things like “Should smokers get lung transplants?”
or “Should alcoholics get liver transplants?” And whenever these discussions arise, there’s an idea often floated called “the principle of voluntary responsibility.” Even if you
haven’t heard the name, you’ve probably come across something like it before. It goes like this: Let’s say you decide to smoke. Why not? It’s addictive and it feels great! But after 40 years of cigarettes you have cancer and you
need a double lung transplant or you are going to die. But so does Jemima – Jemima has
cystic fibrosis, it’s a condition that affects the lungs. It’s genetic – she was born with it – she did not make any voluntary decision that got her here, unlike your voluntary decision to smoke. And wouldn’t you know it, there are only enough lungs for one of you. If you hadn’t decided to smoke all those years ago she would have just gotten the transplant but because you now needs those lungs too her future is in jeopardy.
We’re going to have to enter some decision-making process, so there’s a chance Jemima might not get those lungs. You’ve put her at risk by creating demand for limited medical resources. The
philosopher Jeff McMahan thinks that you have a moral duty to make sure Jemima gets those
lungs before you do. That’s the Principle of Voluntary Responsibility – if you make a voluntary decision that puts somebody else in harm’s way, you are on the hook for getting
them out of it. McMahan thinks that it is right for smokers to be denied lung transplants
if there are other people waiting. And that we could extend that principle to other people as well. To a lot of people that sounds reasonable
at first, especially in the UK and the USA where “personal responsibility” is a big
tenet of political and economic philosophy. “Yeah, if you get sick and it’s your fault
why should someone else suffer so you can get better?” But here’s the kicker. ‘Smoking’ can be substituted for any medical condition that somebody develops as a result of making any voluntary choice. And ‘lungs’ can be substituted for any medical resource, including money and time. If there are enough lungs for both you and Jemima but only one surgeon, or only enough time in the day to do one operation then Jemima gets them, every time. And Jemima with her
cystic fibrosis can be substituted for anybody with any medical condition that they develop through no choice of their own. If you need a lung transplant because of your smoking but somebody else gets shot in the kidneys and requires a completely different king of procedure, well still, you cannot get any treatment until they are completely
fixed. That’s a logical requirement: the principle of voluntary responsibility has no room for half measures and arbitrary decisions. This principle is so much more demanding than a lot of people realise. The philosopher Dan Wikler points out that if we really committed to
this we would deprioritise healthcare for every single case of sexually transmitted infection, every single case of AIDS, and every single pregnancy, except in cases of rape or infected blood transfusion. Because those are all cases in which somebody needs healthcare as a result of voluntarily
choosing to have sex. So all the cystic fibrosis patients have to be seen first. Every attempted suicide who comes in would
get left in the corridor. Maybe even stuff like food poisoning: you chose to eat shellfish
rather than a veggie burger, you knew the risks! And again, when I say these would be deprioritised I mean funding for them would be entirely removed until every single nonvoluntary healthcare
condition was completely fixed. If you’re pregnant you cannot receive a single second
or penny of medical attention until cancer is cured. If you believe in the principle
of voluntary responsibility that is what you are logically committed to. So things get pretty unrecognisable pretty fast if we start allocating healthcare based on who we think is responsible for their own condition. You might also wondering, just on a practical level, how can we even tell to what degree somebody is responsible for the state of their health, and it’s funny you should ask that because: PART 2 – Just on a Practical level, How
Can WeNnobody ever seems to talk about applying the principle of voluntary responsibility consistently or completely. In the UK at least it always seems to come down to smokers and fat people So why? Well, part of the story is that it’s to do with risk, especially if we’re talking about surgery. All surgery
carries an element of risk: it’s the last legal bloodsport in England, as a surgeon
once told me. And if you are very fat or you smoke, that can correlate with other conditions that could mean surgery carries greater risks for you than it would for somebody who didn’t have those other factors. The medical term for other factors like that is ‘comorbidities.’ But that prompts the rather interesting question of how we do measure risk when it comes to allocating healthcare resources? A study in the journal Bioethics asked subjects
to look at fictional patient files and decide who should get organ transplants in cases when there weren’t enough organs to go around. The authors asked 283 people, which they admit
is not a representative sample size of the public, to decide who should get a heart transplant between patients with or without histories of smoking, with or without histories
intravenous drug use, and with or without histories of eating high fat diets against
doctors’ advice. “Subjects were significantly less willing
to distribute organs to intravenous drug users than to cigarette smokers or people eating
high fat diets, even when intravenous drug users had better transplant outcomes than
other patients. Subjects’ allocation decisions were influenced by transplant prognosis, but
not by whether the behaviour in question was causally responsible for the patients’ organ
failure… People’s unwillingness to give scarce transplantable organs to patients with
controversial behaviours cannot be explained totally on the basis of those behaviours either
causing their primary organ failure or making them have worse transplant prognoses. Instead,
many people believe that such patients are simply less worthy of scarce transplantable
organs… It is not uncommon for people to argue in favour of allocating resources on
the basis on personal responsibility. What our study shows is that these arguments may
be convenient ways to support what otherwise merely reflect social desirability judgments.” In other words, when human beings make decisions about who should get healthcare we might be vulnerable to making those decisions based not on how much good could be achieved or on the risk, but who we think is deserving. I say might be vulnerable because, in fairness, that is only one study
and it has its limitations, like the sample size. It only investigated behaviours like drug use and smoking as well: it didn’t investigate how things like gender or race might impact healthcare decisions. In her book Fatal Invention, bioethicist Dorothy Roberts laments that black
and Latinx patients in some studies have been shown to be under prescribed pain relief compared
to white patients with similar conditions, and to wait longer for emergency treatment. Although that study I quoted did investigate how subjects viewed people who have high-fat diets, it didn’t investigate how they view fat people specifically. Fat people are discriminated against in employment, in education, and even
in court. Being fat is stereotypically associated with being lazy, and slow, or unintelligent,
it’s assumed to be your fault, as if a) being fat is a problem, and b) social
factors like access to what sorts of diets are available for who just aren’t a thing. Sources for all of that in the doobleydoo and thank you to Kivan Bay on Twitter
for introducing me to the word of fat studies. In her book Heavy, communications professor
Helen Shugart examines the various ways Anglophone countries talk about fatness and obesity,
the contradictions and implications of the various discourses surrounding it, including
the ones that lean heavily on “personal responsibility,” as well as the downright
myths and junk science. What she highlights is that, “These questions defy simple answers,
not only or even primarily due to complex and still unfolding science but because fat
and, accordingly, obesity can only be understood – indeed, can only mean anything at all
– within the historical and cultural context in which they occur… Intervention in cultural
or health issues cannot ever be simply about “the facts,” whether because those facts
are themselves a cultural product or because the facts are bad.” But the flipside of the personal responsibility argument might be that even if we can’t tell exactly how responsible somebody is for what or even whether that idea actually makes sense, I know a freeloader when I see one and I don’t want my tax money going to support somebody who’s just going to waste it on self-destructive behaviour. And if that’s your stance then I understand, but I don’t really know how to argue with you on that one because I do want that. I’m okay with my tax money,
what little of it there is admittedly, going to support somebody who is sick, regardless of whether they are responsible for their condition, assuming that idea even makes
enough sense to be practically useful, because I just think that healing the sick and helping people is a good thing to do. Even if you aren’t religious, and I’m not religious either, there is a reason that people used to think healing the sick was a sign of divine deliverance.
It sucks being ill, it consumes everything else in your life – you could be the richest person in the world but if you don’t have your health you’re gonna be miserable. It sucks having to go to hospital, and if I can help anyone lessen the amount of time that anybody spends in that situation then I guess I just think I ought to do that. Part 3 – Context & Power I’m gonna use a little bit of postmodernism
here, so all you Jordan Peterson fans put your earplugs in now. The French philosopher
Michel Foucault said that in the old days political power used to control the bodies of individual people. It would publicly execute you or brand you or torture you if you disobeyed the rules.
Nowadays though, it controls the bodies of groups of people through what he called ‘biopolitics,’ which includes things like public standards of hygiene, public vaccination programs, and,
of course, funding for healthcare. Rather than dealing with the individual, “Biopolitics
deals with the population as political problem.” And there’s an interesting tension there
between the biopolitical standards to which whole populations are held, and the often very individualistic personal responsibility angle with which we on the ground are expected to engage with healthcare providers. At its best this expansion of power into biopolitics
produces things like public vaccination programmes, which help save lives. At worst it produces things
like people with Deafness being banned from learning Sign and women being barred from getting
abortions. Foucault’s point is that power is never neutral in the norms that it appeals to. No biopolitical decision about who gets healthcare can ever be unbiased, can ever be immune
to fatphobia, transphobia, ableism, classism, racism, and whatever, because, as Shugart notes, any appeal to the medical facts presumes a certain context in which those facts matter. Thank you for re-joining us Jordan Peterson
fans. That was only a small dose of postmodernism, so you should be okay. Just as a precaution though you probably shouldn’t actually read any philosophy for at least 24 hours after this. So you’ll probably be fine, right? You might be worried about the ways in which power dynamics can creep into discussions about healthcare. Like Ted Cruz. He’s worried that a system
like the one we have in the UK gives the state power over human lives. Trouble is though,
that’s kindof what states do, unavoidably, and Mister Cruz can give us a great example of this. Ted not only believes in the death penalty just as part of his political life, but as solicitor general for the state of Texas defended the state’s right to execute its citizens on five occasions. Now, whatever you think of the death penalty, you’ve surely gotta admit that it is definitely the state having power over human lives. And
even in a country like mine where we try not to execute our citizens, the government still has power over human lives because that’s what a government does. So rather than deny that power isn’t there, I think it’s more fruitful to talk about what flavour of power it is. There are all kinds of background factors that shape power and how it operates, but because I’m a raging Leftist SJW I’m particularly interested in
the political economic factors. The political economic context in my country,
and in the United States, is neoliberalism, an economic philosophy that not only loves
free markets and individualism, but also uses the state to create them. For neoliberals,
freedom for humans means freedom of the markets, and the ideal subject is an individual, isolated consumer. I’ve discussed neoliberalism in more detail before. You can see that video by clicking the card that’s just appeared in the top-right. The construction of choice, where ‘choice’ means a free market, is key to neoliberalism, and it’s how it spreads from being a political economic philosophy to a force that shapes
our lives and even our selves; you might have seen some American political commentators talking about how they worry a free healthcare service would deprive them of the ability to choose their providers. Shugart writes, “Neoliberalism ascribes virtually all responsibility for
personal and social welfare to the individual, which is further articulated as crucial to
individual liberty under the auspices of choice… Importantly, this choice is tightly linked
with consumption to the extent that individuals are expected to choose with their dollars
and thus customise priorities (and goods and services to the end of realising them) that
matter to them – in this way, exercising their individual choice is articulated as
tantamount to democracy… Under this framework, the practical role of government is to facilitate
the market; moreover, government intervention at any level – in the form of social services,
for instance, or with respect to regulation of industry – is represented as cultivating
or enabling dependence and, more to the point, undemocratic, thus hampering if not denying
individual liberties and aspirations.” Of course, it’s also true that these markets are great at making rich people richer. And we might wonder what that choice
really amounts to, especially if you can’t afford healthcare at all. These concerns – profit, politics, “choice” – are important forces that shape the context of healthcare discussions.
And that’s why there’s never really any serious discussion about applying the philosophical principle of voluntary responsibility to its full extent. Because it isn’t really about resource management or personal responsibility; it’s about power managing bodies. As an example, in my country healthcare discussions are often deliberately held in the framework of “what the NHS can afford” but the NHS could afford to look after everybody. That is a thing that we could do. Just like we could house every homeless person: there are more empty houses than there are homeless people; it’s not a question of there not being enough resources. We don’t do it because we choose not to, and the same is true of healthcare. “Limited resources”
are often limited artificially by the choice to lower taxes, to permit corporate tax avoidance, or to just spend that money on other stuff. And whether you think that choice is ultimately for the best or not depends on your political conscience. But in a very wealthy country like mine or the United States, who gets healthcare and where resources are distributed is a question of choice, not
of scarcity. And so we cannot avoid discussing the values that will guide that choice. Patreon.com/PhilosophyTube is where you can
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Comments

(100 Comments)

  • Aurora Rigel

    OOOHHHH!
    So it's like we all elected Thanos and he did the snap because Jeff Bezos slid him a couple of millions.

  • James Netwall

    This kind of thinking and a so-called ethical decision making just leaves me shaking my head. Why are we the cruelest creature on the planet to ourselves is it because we ran out of opponents on our way to the top and so now all we have to do is to beat up on ourselves I mean human beings are cruel to each other on a level that would make the devil cringe. And anybody that's able to just cast people aside is sick and does not deserve to be here at all is why I advocate for late- life abortions

  • Sara Marie

    I work in a transplant unit (In a leading facility in the US) and Unfortunately Smoking and Obesity also cause you to be wayyy riskier. Like you are wayyyyy more likely to have a stoke or not heal completely because of the systemic effects of smoking, obesity or drinking on small capillaries and other organ systems. But in patients with Cystic Fibrosis this will be a complete solution to a problem , their healing process will not be delayed or prolonged because of their CF. I really wish it was this simple. And I wish we could get organs to everyone but a lot of the conditions that cause you to need the Organs also make your recovery very complicated and dangerous. Non-compliance with rejection medications and a lot of other factors play a role here. The medications are really expensive and MUST be taken. I think that Tobacco companies and High calorie vendors should be help accountable for their predatory taking advantage of sooo many people . Sorry so scattered. It is just a complex issue here.

  • Andy Meier

    The way this is presented is so disingenuous. Present extremes, first the one we want to refute that sounds reasonable. Then point at its fallacies. Next step present the one we like without pointing out its fallacies. The best outcome lies somewhere in between these two extremes. At what point do you refuse to treat someone who actively creates their own problems. I don't know, but its now never.

  • Schism704

    The main problem with your solution (not just to health care it seems but to all societies ills), i.e. to raise taxes on the rich, is that it will simply cause the phenomenon known as capital flight. In which the rich (the most mobile entity on earth) leave the country. Which is what happened in Venezuela. This causes huge levels of unemployment, and huge price rises, as businesses are forced to significantly raise prices in order to survive the tax burden imposed upon them too. Which is what happened in Venezuela. The next step in crisis management will be to confiscate the wealth by force, which then converts the nation into a dictatorship. Which is what happened in Venezuela. With the state in the place of the free market conditions decline: Without competition to drive innovation, both in the quality and quantity of products and the lowering of a products cost, government spending skyrockets. On top of this, now that being rich is impossible, individuals no longer have an incentive to work hard. This too happened in Venezuela. After the government runs out of money it is forced to print and borrow money. Both of these tactics send the nation down the road of hyperinflation and poverty for all. So you too can enjoy eating roadkill in Venezuela.

  • Patrick Cavanagh

    Many people that abuse substances, whether it be alcohol or heroin, benzodiazepines etc. are often trying to block out trauma of the past, abuse done to them, or self medication of an undiagnosed neurological condition, e.g. ASD, ADHD.

  • Miles LeBlanc

    So economics of a select group of rich fucks getting to exploit the needs of the people to gain even more power and money to buy all these things they don't need over a lot of innocent people against a tough divide having to suffer when a lack of health care can literally kill people? Yup, sounds like American Economics to me.

  • Sean H

    Now with short quotes voiced by Marvin the Paranoid Android!

  • Volker Siegel

    I feel that "pregnancy" as an example of voluntary medical condition is not very good. Somehow "pregnancy" is in a fundamental way different from voluntary medical condition that are clearly pathological. That makes the whole explanation potentially inconsistent, without advantage. (At least it's easy to build a contradicting argument from it for an attack)

  • Veterator Vulpes

    I know how to argue the point at 10:48. The fundamental issue is that often times people take a purely linear approach to solving philosophical problems of morality, when the simple fact of the matter is that in a logistical sense, the solution which promotes the optimal outcome often has inherent in efficiencies built into it, which you could remove by design, but in doing so reconstruct the situation such that you have less net output because of nonlinearities that exist within the system as a whole. At that point you have to argue by saying 'do you want the best outcome overall, or do you morally rate the existence of inefficiencies as a viable way to excuse potentially creating more suffering overall?' In this way, it's much like the justice system, in which deciding whether to be more strict and risk incarcerating innocent people in exchange for improving the probability that all actually guilty parties are convicted, or structuring on burden of proof such that some guilty parties may go free but fewer innocents are punished unustly. some people will obviously argue that you could in theory construct a perfect system which has no false positives or false negatives, but baseline reality shows that that's simply not realistically achievable and so the question you're really asking is 'what do you value'. of course if someone then says that they do indeed value the existence of greater suffering overall if it means that fewer cases of waste exist. If they specifically cop to the fact that they're okay with people who need care not getting it because the Injustice of the people marginalized by the inherent imperfection of the optimal situation being confronted with people who are suffering less having their pain alleviated while they go on, then the real question becomes how do you find a translation between their moral framework and yours, such that you can work to a solution which satisfies needs of both, or understand that inherent conflict exists between irreconcilable differences and bask in the warm glow of the knowledge that all human experience is built on kernels of paradox.

  • NinjaSheep

    I do get your logic and agree with you. Regardless of choice you should be cared for to the full capacity of the countries abilities. However being fat is unhealthy and a poor choice for the vast majority of fat people. There are factors which make fatness harder to avoid and some very rare conditions which basically ensure fatness however becoming skinny is physically possible and medically healthy for the vast majority of fat people.

    This isn’t me saying that fat people should be denied knee surgery or heart surgery just that if you can you should avoid it. I personally am overweight due in large part because of major depression and crippling social anxiety. However now that I am better I feel I should diet and exercise to preserve my health.

  • Wondering Spirit

    I suppose we care less about smokers and fat people because we are an anti smoking and anti over eating culture. We support aids patients and pregnant women because we are far more positive about sex and we want babies to be born.

  • Loui P

    Only 3 min into the video and if you smoke yes u should be denied a lung transplant

  • johnnyscifi

    Coincidentally, im very sick right nlw as i type this…

  • LordSlag

    Any position can be railroaded to reductio ad absurdum if you intentionally misunderstand it like you did here.

  • Taran Van Hemert

    "If you think a non-smoker should be prioritized over a smoker for a lung transplant, you MUST also accept that we can't spend a single second or penny of medical attention toward pregnancy, until cancer is cured. " 5:20

    WHAT?? No I don't. This is just some bizarre slippery slope fallacy. Is he joking??
    Olly seems like a smart guy who knows what he's talking about. He produces slick-looking videos, narrated with a fantastic English accent. It's easy to be pulled in by his charm and charisma, and just accept what he's saying, because, hell, he knows a bunch of stuff about philosophy, and I don't! He must be right!
    That argument, right there, is so bizarre, and so wrong… but I couldn't possibly debate Olly on the subject, because he has far more debate experience than I do, and would win the argument even if his position really is, in fact, wrong. Smart people are very good at defending their views, even the ones that are wrong.

    Just my 2 cents. Be wary.

  • Music Account

    Ted Cruz would apparently prefer people being slaves to unregulated private corporations that are only accountable to their shareholders, rather than the government.

  • Shane Keefer

    So like, most people who are "fat" aren't fat because of personal choices (at least not solely). A lot of people are just medically predisposed to it and have very low metabolisms. There are so many conditions that cause people to be overweight as well. Polycystic ovary syndrome (PCOS) or hypothryroidism are a couple of examples where it is very difficult even with healthy lifestyle choices for those people to keep their body weight down. People who are stuck in poverty become limited in their food decisions because they are poor meaning less balanced diets. Usually carbs are the cheapest things to buy and fill you up fast so you can feel less hungry. Carbs are good within reason, but it turns into sugar in your body. So large quantities increases risk of conditions like obesity and diabetes. Also many medications cause weight gain. Like if you have PTSD and develop psychosis, the main side-effect of pretty much all anti-psychotics is weight gain. Furthermore, someone's BMI isn't an indication a lot of times if they are unhealthy or not. I am pretty unhealthy but have a lower BMI. I'm not that strong. My best friend with a high BMI and by society's standards "fat" is way stronger. They biked over 10 miles to school before. I could never. I know people with high BMI's that eat healthier than me. It really isn't a good indication of anything really. Also where is the talk about denying healthcare to people with low BMIs and that they should eat more or whatever? People with low BMIs are considered by society automatically "healthy" and they are automatically considered not lazy and all that. I can't tell you how many times people have assumed that I am athletic because I am thin. I'm not. So that's just the weight thing. Smoking people get into for a myriad of reasons like as a coping mechanism for anxiety so though technically it's mostly a choice at first it can be hard to resist such measures say if you don't have access to mental healthcare. Nicotine is addictive so it is hard to stop, and it doesn't take long for it become addictive. At that point, the more you do it, the higher the risk of developing the conditions. Some babies are born with nicotine addiction if the parent carrying them was a smoker making them more likely to smoke later on. People who live around smokers can be adversely effected and be at risk for the same conditions that smokers are at risk for (second-hand smoke). Some people are more predisposed to developing addictions in general because of genetic/environmental factors. Addiction needs to stop being demonized. By this logic, pretty much everyone with an addiction should be refused treatment. I could go on about this for a long long time. I'm not British, but with how much the UK spends on things like making sure the royal family lives lavish lifestyles, there is plenty of money/resources that can be diverted towards providing healthcare. I know that the royal family is a significant part of culture and society in the UK, have influence all over the world, even still influence the political sphere, etc., there really is no moral justification for diverting funds and resources so that one family who are made up of human beings no different than any other person, whose blood is only significant because people deem it significant, should be hogging funds. Divert money away from military endeavors and modern day imperialism because the UK is still an imperialist country like the United States where I am from. Like I said, I could keep going.

  • Shane Keefer

    Oh and speaking of the royal family, I'm sure if any of them got fat or are fat, they'd be exempt from the "personal responsibility" rule. Actually pretty much anybody who is rich lol. It's just another tool for discrimination and pinning the working class against themselves by blaming their lack of medical care on a smoker instead of those on the top preventing them from gaining healthcare by hoarding resources for themselves 🙂

  • Ha La

    In certain healthcare situations, despite having usually sufficient resources (there is no such thing as infinite resources in healthcare, in my opinion) choices must be made and personal responsibility seems to make sense to me at least. Some healthcare systems are already the result of significant tax rates on the rich….should we evaluate other aspects like efficiency of using current resources than keep taking more money from the rich using the money inefficiently (shown in UK PFI in building hospitals and US high high high medical care costs) and assume their money as infinite???

  • Aleksander Karłowski

    Just because someone can agree with Jordan Peterson on some topicks doesn't mean they are ignorant to other points of view and blindly ignore them. I get it's a joke, and I acknowledge that you make valid point, what's more I even agree with you on this matter! But it's anoying to hear the same joke in every other vidoe you make.

  • I Like Grapes

    Fuck yeah we should allocate resources based on worthiness
    sub-human junkie scum get no sympathy from me

  • whereisawesomeness

    What I think is interesting about the principle of voluntary responsibility is that it simplifies the notion of risk significantly. To use the example provided, Jemima could choose not to have the transplant and just die instead (a shit choice, but a choice nonetheless). So if the transplant goes wrong, Jemima can't be allocated any time or funding for medical care until all involuntary conditions are cured. Of course, the objection is that Jemima doesn't really have a choice, which raises the question of what constitutes a "real" choice. The smoker has taken a risk, but maybe smoking helps with their ability to cope with stress, in which case the alternative also possesses a health risk. Risk is more complicated than the principle assumes

  • lilah

    The only thought I have on the whole transplant argument is that organ donations aren’t easy to come by, and say a person receiving a liver transplant was an alcoholic, there’s no guarantee they wouldn’t destroy the new liver. You could know this with a non alcoholic patient. I don’t know if this has to do with whether you deserve treatment because you caused your symptoms, it was just a thought.

  • Klaus Gartenstiel

    on a case to case basis

    as it happens in reality, contrary to philosophy

  • Christina Nelson

    What if the suicidal thoughts are caused by a mental disorder?? Love your channel

  • John Smith

    "The principle of voluntary responsibility leaves no room for half measures or arbitrary decisions." What if it did though, or something like it? I would be fine considering both relative need and relative self harm in determining who gets limited resources. So someone who is dying but caused it themselves could still get treatment before someone who needs help for mild symptoms through no fault of their own.

  • Pete Peterson

    Cf. welfare and drug testing.

  • William Redding

    I contest the implication that there's nothing wrong with being fat. If you believe that people should be healthy, you believe people shouldn’t be fat.

  • Ryan Senger

    A study with 283 people is actually quite a reasonable sample size – this would give you roughly a 95% confidence with a margin of error of about 5%. That means the confidence in the study could range from 90%-100% accurate.

  • screwsinabell

    Holy shit. I never knew I could get pregnant through a blood transfusion! That's fucked. Are you sure about this? Even if I'm a dude?

  • Lady Morwen Daebrethil - Feanissil

    Tories are bullshit.

  • Riot Grrrl

    You can't just consider the patient him or herself. What about the relatives and people who love that patient?
    If my boyfriend whom I love to death smokes his lungs away, because he now is addicted and started in his childhood, what can I do to stop him except support him in quitting smoking? What if I don't succeed?
    What have I done to deserve to suffer watching him suffering, just because some people believe in free will and want to deny him health care?

  • RookRegent

    sometimes people forget that thicker people can be disabled Before we gain weight. its almost like disabilities that restrict movement and pills with certain side effects can cause you to be fatter regardless of what you want.

  • RookRegent

    Scarcity is a lie. Harvest the organs of the Rich.

  • Name Here

    I find it very telling when people do and don't seem to care about resources being "limited".

  • Dynamitewolf t4

    In capitalism its about who has the most money

  • Marco Meijer

    Everyone does self-destructive behaviour in some ways. Maybe they play video games until way too late and sleep too little. Maybe they drink. Maybe they smoke. The solution is clear: healthcare for no one!

  • RagingNebula217

    The professor who wrote Fatal Invention teaches at my university, and I got to meet her at a dinner discussion at my dormitory and pick her brain. She was absolutely brilliant. Highly recommend her work.

  • RagingNebula217

    To me, this is like a case of Hume's Guillotine. The facts or descriptions surrounding someone's health profile do not automatically proscribe any sort of moral or ethical judgement about their care, i.e. that leap between description and proscription implies a value or aesthetic tendency.

  • Rowan

    also so much of these things are genetic

    some people are genetically much more likely to have an addiction, or naturally have a much higher bmi just from their genetics
    we like to blame people for their "lifestyles" without thinking of why that is how they live.
    cant afford a good diet? now theyre overweight. now you wont give them health care
    lived in a bad neighborhood – now theyre more likely to smoke/ do drugs because of the people around them that have influenced them
    oh look folks its classism

  • bbq seitan

    As an inspiring nutritionist i do believe in a level of personal responsibility when it comes to your own personal health.
    BUT. BUT. BUT.
    I do believe helthcare is a human right.
    You can do both.

  • Carolyn Talbot

    In the US, we just make health insurance for smokers cost prohibitive, knowing that chronic smokers generally tend to be poor. We also market cigarettes to this demographic and offer far more points of sale in thier neighborhoods.
    We also have created food desserts in poor areas, where heavily processed and fatty foods are readily available while healthier choices are not. Lots of dollar stores, and very few fresh markets (whose offerings are pricey by comparison, with a short shelf-life.)

  • Khanalas

    Okay, let's agree that "Personal Responsibility" isn't a good way to determine healthcare distribution. Then, what is? Like, this video explains why that system is [shit and unjust] but that's life's universal state, pointing out that anything is [shit and unjust] from some perspective is a nonwork.

  • Ashton Armbrister

    This is a bunch of slippery slope right here. You could successfully make a law that said that drug addicts (including smoking and alcohol) in particular are de-prioritized without screwing over pregnant people.

  • Viridian

    Just be like china and take the organs from political dissenters and undesirable ethnic groups by force, then sell them to the rich because it seems like money at the end of the day is the final moral arbiter. When offered with real wealth in hand people often act different then how they say or think they would act. We view ourselves virtuous when the hypothetical is offered and act practical when the real deal happens and justify the "bad" choice after we have the money. Is virtue all an illusion until tested? Like a quantum particle?

  • ptanyuh

    Just shut up and cover it, in my opinion. It's part of being in a free society.
    I don't own a car—should I demand that drivers pay more for healthcare because they put themselves at a higher risk every day than I do? No, that's silly.
    Just stop judging people, GROW A FUCKING HEART, and pay your fucking taxes.

  • Horesmi

    11:58 Me, a Jordan Peterson fan:
    That's… Why I'm here.

  • Samuel Marsden

    Yeah, I still agree with the original example.

  • handsbasic

    Great video! Small nitpick: I want to say that in a lot of places, HIV/AIDS can be passed down through birth because the medical / birthing infrastructure isn't there to prevent it. Not every person with AIDS chose it. This is an especially pernicious problem in poorer countries in Africa.

  • observersum

    Thanx!

  • Chris Schiebelbein

    I'm respond in third person here because I was referred to this by someone else.. lots of problems in this video.

    He states that voluntary responsibility is black and white, it isn't. There is a big difference between requiring someone be sober for 6 months versus deprioritizing all non-voluntary healthcare. This is made obvious by the fact that we have working health systems that use principles of voluntary responsibility but still treat people who were the cause of their own disease.

    At a point in the videos he states that he believes we should "save" the sick person, referring to the "addict", and no one is saying we ought not save the sick person, the problem is we have limited resources. He states we cannot make decisions about who is "more responsible", but we can. A severe alcoholic is identifiable. He later, near the end, talks about scarcity with an analogy about housing. The thing is, we don't give the homeless people the freehouse for the same reason we don't give the severe alcoholic the free liver.. because the chances that they will ruin the liver is significantly higher than that they won't. I don't buy the claim that there are more houses than there are homeless people, but there isn't more livers than people who need liver transplants, so the argument is moot to begin with.

  • SoulfuzZ

    Just a friendly reminder that Foucault petitioned to have the age of consent laws completely abolished.

  • Diana Eidson

    Conceivably, some cancers are caused by life choices. How do we know who or what is responsible when someone gets cancer?

  • Tovah Gladstone

    It was in this video I realized that philosophers do not understand the process of organ transplants and how the lists are made.

  • Slander Sir

    13:53 Oh my god. Wow.

  • Kristy Mounsey

    Two points of this video.
    The concept of some being deserving and some people being undeserving frightens me. I see this continuously in Australian politics to do with welfare.
    As a disabled woman I face fat shaming a lot because my disablity is ‘invisible’ despite the reality that medication was a major factor in my weight gain. I also resent the fact people think I owe them an explanation. That they don’t owe me the right to respect my privacy.
    As you have done videos critically examining transphobia, and racism etc…I’d love you to do a whole video on ableism and how it’s perpetuated by capitalism. How under capitalism people with disabilities are often excluded from labour markets and also portrayed as a burden in society rather then appreciated as part of diversity.

  • Bedevere

    @17:55 lets be clear that we make these choices based upon profit. We choose not to distribute spare resources because it isn't making anyone money, so we throw away food, etc.

  • Electro-Cute

    There is a story about an extremely overweight man who managed to loose a lot of weight down to what would be seen as a normal weight. He did this by watching aerobics videos and followed the instructions. It was very much a miracle of a mans will to lose weight for the sake of his family.
    This man watched the videos of a specific instructor trough out his weight los. For this guy that instructor was his hero. But then suddenly the instructor died and the man fell in to depression and started eating again. It didn't take long until he ate him self to death.
    To you who think people are more or less deserving of health care. If we could have saved this man's life would you still bitch about his weight problems. It is almost as if things aren't as simple as good and bad.

  • seaside scott

    I still cringe each time you say neoliberals or capitalists desire a 'free market'. The goal of either is absolute wealth and power, a competition, a game won by achieving monopoly. Even A. Rand's 'Atlas Shrugged' only had one member from any given field. To your credit you speak of their use of gov't to extort wealth and power from the populace. I see the role of a socialist gov't to be that of keeping the playing field relatively even, thus ensuring a free market for the majority of people. For decades in the USA the bigger corporations have written the regulations and lawyered up to ignore them while encouraging their enforcement on less powerful competitors. Goodbye small business.

  • ProfPille

    Junk science? More like Junk food science!

  • funsnailzzzz23

    I love your other stuff Ollie but I gotta tell you to fuck off on this one. My best friend died from CF waiting for a lung transplant. You're committing slippery slope to justify it.

  • Bob Newby Superhero

    We could skip the transplant question altogether by alleviating organ shortages by having more people willing donate their bodies and organs upon death.

  • Bob Newby Superhero

    Hard determinism throws a bit of a wrench into the works here. What happened in the person’s life to cause them to begin smoking? How hard have they tried to quit? How many times? The behavior itself, if determinism is to be believed, had an inescapable root cause all it’s own. Which makes it a thorny question as to whether or not it’s their fault.

  • Rinsuu

    Seeing a thinner person actually give a shit about fat people is so radical to me. Thank you ;_;

    I've basically been fat for all my life and was diagnosed with type 2 diabetes when I was 18. I'm well aware most people think I'm just a waste of NHS resources and I hate it. But hey with how things are going the NHS might not even be a thing for much longer… Hooray?

  • Mick Wayne

    Very smooth segue at the end to the Patreon spiel ^_^

  • Maciek Fedorowiat

    On a practical level smokers will probably keep on smoking, alcoholics will keep on drinking and fat people will keep on overeating. As brutal as it may sound we should prioritize people who may really benefit from rare organ transplants rather than putting them on the same level with people who will just prolong their destructive behavior.

  • 3 am

    i only got diagnosed with my chronic illnesses (of which there are 3) after i had two traumatic brain injuries, as those can often cause dormant or not very bad illnesses to show themselves. i'm chronically ill because i went to high school and walked into the way of a frisbee. no healthcare for me

  • ethomps12

    Super interesting. I never thought about why I’m ok with treating IV drug users for endocarditis, hepatitis, HIV, and even actively support harm reduction like needle exchange and suboxone, but wouldn’t necessarily give a lung transplant to an active IV drug user. But really I think it’s more because I’m concerned about them squandering a very valuable gift. It’s like how a mom of an addict finally shuts her kid out of the house because he keeps stealing her TV and selling it for drug money. Organs aren’t equivalent with other interventions because no one has to die for those. I don’t know someone feel free to tell me why I’m wrong

  • Communist Trash

    I hate that I agreed with restricting healthcare

  • Brian Cole

    I appreciate the concern people have with the government making decisions on who lives and who dies, but once you start thinking about it for longer than a few minutes, you rapidly realize that you're choosing between either the government making this choice or money. Who deserves the transplant? The one with greater financial power, obviously. That's the system we live in here in the US. So which is better? Personally if I had to choose, I'll take the one that doesn't depend upon an individual's bank account.

  • Brian Cole

    16:00 omg I'm in the US and I DON'T have the right to choose my provider! My insurance only covers certain providers, as do most insurance plans in the US. I can't go to my preferred doctor if they are outside of my insurance's network. And I often don't get to choose my insurance, either, since the majority of us can only get insurance through our employer otherwise it's too expensive.

  • BillieCupcake

    In the topic of it being a grey area trying to figure out who is responsible for their own health problems — I was born with a genetic disorder that WILL get worse as I age and part of how quickly your body degenerates is how quickly it's caught and how well you prevent your joints taking damage. I didn't choose to be born with this condition, but could I be denied treatments down the road if I choose to not do physio, wear braces, etc.? What about damage that could've been prevented if I was diagnosed when I first started showing signs, at age 4, instead of now that I'm an adult? Am I held responsible for that delay or should the finger be pointed at the adults who looked after me and gaslight me/ignored my problems?

  • Xд Lдсдд

    as far as I know: Lung cancer is not an indication for transplant, any cancer is contraindication for solid organ transplant except liver and localized liver cancer.

  • Elephant in the room

    The thing about being fat is, it's not always a fat person's fault that they're fat. If you were raised in a poor household where you had to eat a lot of cheap foods that are high in carbs and low in all other nutrients (pasta, rice, breads, ect.) because your family could not afford to buy "healthy" foods that are often much more expensive than the "unhealthy" foods.
    In that situation guess what, you're gonna gain weight.
    People with binge eating disorders are often times overweight and need treatment to manage the disorder.
    People with depression won't have the energy to go out and exercise, and they'll often times eat foods that are easy to make and high in carbs/sugar because sugar is addictive and people with depression are more susceptible to that particular addiction because sugar triggers releases of dopamine (what makes you happy), so really in a way, it's a form of unintentional self medication.
    And guess what! People with depression will usually need medical attention to manage their condition in order to lose weight and become "healthy".
    I was raised in a family that was lower in economic class and we didn't always eat very well. I was considered overweight When I was 7 and it never got any better.
    When I was 18 I had spiralled into anxiety so deeply that I stopped eating because my stomach was constantly in knots. I went from 250 Lbs. To 190 Lbs. In like 6 months and I felt *horrible*. All while everyone was congratulating me on my weight loss, telling me how good I looked, how I must be getting so healthy, to keep it up! When I didn't want anyone to even look at me because I didn't want my body to be an object for people to judge.
    I was always shaking and eating was something I dreaded because I was constantly nauseous and I was always tired to the point of feeling faint.
    Once I got medication for my anxiety, I was able to eat again and (much to my own disappointment) I gained all the weight back. Cause I could eat again and the food I usually have access too isn't very healthy.

    So yeah. Discriminating against someone due to weight is pretty gross.

  • sei amoi leiwaund

    voluntary personal responsibility sounds nice at first because imo it can be something one can set as an individual ideal to follow when possible, but not as a generalized and enforced social norm

  • katherine lambert

    As a student nurse I’m scared of going into a healthcare system like this

  • artbyejerblom

    O damn I like your argument about which ones deserves medical aid!

  • Hannah Calzone

    I went to go eat with my boomer ass dad and he went on one of his rants about how socialist healthcare is bad because people who don’t really need insulin will go and buy a bunch. Bitch what?!?!

  • Nils Vos

    Please run for political office. We need people like you in places of actual power.

  • TB

    Does anybody know how postmodernism relate to health and illness? What they believe in for health and illness?

  • Dong Harvey

    If it's right for somebody to be forced to change their lifestyle so as to protect somebody completely unrelated, then on a utilitarian basis,

    we should kill the rich?

  • Keelan Anacheka-Nasemann

    RE Shugart, "Heavy:" don't throw out the baby with the bathwater. If we commit fully to the idea that "the facts" cannot instruct medical or social interventions relating to Obesity, then attempting medical treatment or providing support to the Obese is morally ambiguous, and could represent a form of social control. This holds regardless of an Obese patients' desire regarding treatment, because you could argue that dominant cultural narratives have achieved hegemonic influence over personal choice.

    On the other hand, if Obese patients are deserving of medical care, that would imply that they deserve equal financial access to "the facts" as culturally practiced, which would imply that Obesity can be understood (and therefore, assisted) in terms of a set of accepted criteria.

  • Keelan Anacheka-Nasemann

    In the United States, healthcare isn't regarded as a human right regardless of personal responsibility. The reasoning is individualistic to the extreme: if others aren't responsible for your condition, they shouldn't be required to pay for it under any circumstances, and forcing them to fund your healthcare would be a greater infringement on their rights than on yours. HAH, as if state-delineated property is anything like Locke's "natural" property rights.

  • Elise Atkinson

    Used to work for a doctor. If you smoked, were very diabetic, were too obese, or had insurance that didn't pay well, your surgery had a higher chance of getting pushed back.

  • BIG CHUNK

    I do recall that the NHS does overemphasize paperwork rather than computers which does waste a fair amount of its money

  • Aza Smith

    Something that has always bothered me about politicians who are against socialized medicine is that they always think that people should have the right to keep their private sector Medical Insurance Companies if they want to. What confuses me about this is other than the Medical Insurance Companies themselves… who actually wants the Medical Insurance Companies?

  • LumpyRex007

    being fat IS a problem.
    It adds to the cost of healthcare.
    Just like being old.
    Just like being ignorant.
    Just like being high on meth.
    Just like being angry.

  • tiesiog ba

    as a smoker im fine to wait in lines due health issues related to smoking, not fine to suffer dental issues im suffering which I will never be able to solve coz probably i will never make a salary that big to save 50k + to adress those issues that are related to malnutrition ive had experienced as child bc my parents were stupid and irresponsible to have me. I hate my life and i have the dental issues I have.

  • CWP

    "Sitting here with nothing on my mind
    Could you possibly afford the time?
    Are we looking for the only cosmonaut?
    The only cosmonaut"

  • Fabulous_Squidward

    Fuck the noises of the lifesupport machines gave me a traumatic flashback the first time I watched this shit. Fml

  • shahriar sharar

    hello, any lawyer sir here?
    My parents has been occuring domestic war for 22 years, and I am going through some mental and physical harrasmenr for each and every day for several times, now I feel I am mentally weak and feeling sick , suffering from brain damages. Now what kind of justics csn I get and how should I start for the legal action?

  • mieliav

    whilst admitting that this is a very complex issue and its underpinnings in neoliberalism are deep- as a smoker, I would give priority to the CF patient.

  • KarolaTea

    Who came up with the idea of denying treatment to fat people until the use weight? Cause surely it wasn't doctors, they should know that obesity can be genetic…

    Idk about other places, but I've always had extra insurance for 'risky' things like sports or work. Usually gets handled directly through the employer/sports team. Idk if my regular health insurance could deny support if I got injured doing 'uninsured' sports though. Also there's a tobacco tax, I would hope that goes into healthcare. (Although I don't know if it actually does.)
    I'm having a real hard time to not begrudge a smoker getting a lung transplant. Mainly cause unlike other "bad habits" smoking also affects other people directly and it makes me sick. But yanno, same applies to people who drive big cars, and I doubt that's ever gonna be taken into account when it comes to healthcare.

  • Helen Chua

    13:40 absolute gold

  • Mr Internet Guy

    I'm happy that even peeps on the right are at least able to object Eugenics. All hope in humanity is not lost.

    Yet

  • Gaylen Oraylee

    10:50
    This was a bit of a bait and switch. You framed the conversation as one of scarcity; there's only one set of lungs and the one who doesn't get them will die. Then changed it to a conversation about how much of one's tax contribution goes to whom. I can think *both* the guy who has smoked a pack a day, every day for 40 years is a little too likely to continue on that trajectory if there is only one set of lungs and two ppl who need lungs … *AND* want my tax dollars to treat everyone. It's unfair to extrapolate a person's position in the first scenario to say that they'd want to deny certain people all treatment whatsoever. That isn't the logical conclusion of the specific scenario you proposed. When you change the degree of scarcity, that changes the need to make an absolute choice. 'I want my funding to pay for them both to be treated!' can't be an answer in this case. You can't cut the lungs in half and give them each one, ala King Solomon. It's not logical to assume that I'd want to deny lungs to Cigarette Smoking Man if there were lungs enough to go around.

  • Xealot

    This is a good video. Your videos tend to be quite good. I want to make it clear that I like the video and agree with you. I have just one problem with the presentation.

    To be fair, it Is entirely possible that voluntary responsibility could be a factor in where patients get triaged, but not in whether they ever receive treatment. Prioritisation doesn't mean you never get treatment until patient A is perfectly fine. It means you don't get treatment until he's either stabilised or dead. Ignoring this sort of solution and dismissing things like it as half-measures goes outside of the way that medicine currently works when making these sorts of decisions.

    For example, when I hurt my back at work last month, I had to wait six hours in the ER to see a doctor. It was hellish. Mostly because I was in a great deal of pain, but more importantly there were people vomiting constantly and running very high fevers, several calls for trauma units, and others in various sorts and stages of peril. Whoever was running the ER decided that immediate treatment for these people was more likely to make a difference in the outcome of their case than in mine. And at least in this case, they were right. I ended up only having muscular damage that would mend eventually, but caused severe pain and put me out of action for quite a while.

    My job is rather hard on the back, there's a lot of lifting that can't be done with the legs. To some extent an argument could be made that I should not have chosen to taeke it if I didn't want the health risks, especially for someone of such bookish build.

    However, I think it is far more interesting to inspect whether sovereign power has a legitimate interest in disincentivising certain behaviours. Continuing from the previous example, if I was fat and thus deprioritised to the point where I had to wait nine hours instead of six, would that be okay? Although I personally lean more towards the "No" camp for reasons similar to those stated in the video, the prioritisation of some life over others is a legitimate philosophical question. If I had hurt myself jumping over a fence after breaking into someone's house, would it be okay for me to be refused treatment? For all my treatment to be delayed? What about for all treatment except any immediately needed to save my life to be put on hold because of my criminality? These questions can have different answers. I think that doctors should avoid making moral judgements when making decisions about who receives treatment. There is no part of any Hippocratic Oath I am aware of that says "I swear never to treat those who engage in behaviours the state dislikes or I deem unethical." However looking at treatment being given to people who smoke or are obese this way makes the issue more complex, and maybe people could come up with good rules avout when doctors should exercise the sovereign power given to them by their position, and to what degree their doing so is acceptable.

  • Avalon Project Wildfire

    Are you aware that the NHS is already deprioritising mental health services for people with addictions? Things such as refusing access to a psychiatrist for a PTSD diagnosis until the person has managed to tackle the symptoms of their PTSD alone (addiction being a symptom of trauma). Things such as refusing CBT and counselling because it "won't work" until the person independently fixes their damaged psyche enough to deal with their demons alone and quit? That aside from telling people with addictions who come in after friends have told them they are worried about their suicidal thoughts that they can't give them any more drugs, even though it was support that was being asked for, not drugs? Good times.

  • TealWolf26

    I find the actual sharks almost as upsetting and triggering as the metaphorical ones. At least the Great White is intellectually honest about ending your life.

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