{"id":248,"date":"2010-02-10T13:25:38","date_gmt":"2010-02-10T12:25:38","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=248"},"modified":"2010-02-10T23:54:30","modified_gmt":"2010-02-10T22:54:30","slug":"parachuting-to-the-front-of-the-queue","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2010\/02\/10\/parachuting-to-the-front-of-the-queue\/","title":{"rendered":"Parachuting to the Front of the Queue?"},"content":{"rendered":"

A curious letter was sent out by the Department of Health the other day to GPs and the Chief Executives of various health authorities, trusts, and so on.\u00a0 The full text is available online<\/a>, but here’s the nub of it:<\/p>\n

<\/strong><\/p>\n

\n

ACCESS TO HEALTH SERVICES FOR MILITARY VETERANS \u2013 PRIORITY TREATMENT<\/strong><\/p>\n

The purpose of this letter is to advise you of the guidance in place to ensure that military veterans receive priority access to NHS secondary care for any conditions which are likely to be related to their service, subject to the clinical needs of all patients.\u00a0 […]\u00a0 GPs are asked, when making referrals relating to a military veteran for diagnosis or treatment, where they are aware of the patient’s veteran status, to record that status as part of the referral. If the patient does not want the GP to record their veteran status the information should not be included. If GPs consider that priority treatment might be appropriate because the condition to which the referral relates is likely to be related to the patient’s time in the services, GPs are asked to include details in the referral.<\/p>\n

<\/strong><\/p>\n

[…]<\/p>\n

The ongoing deployment of UK armed forces means it is now more important than ever that the NHS works closely with military services to ensure that the health needs of the Armed Forces, their families and veterans are appropriately met. In particular, it will be important to provide priority treatment, including appropriate mental health treatment, for veterans with conditions related to their service, subject to the clinical needs of others.<\/p>\n<\/blockquote>\n

I automatically bristled when I saw the headline, because it’s hard to argue against anything done on behalf of “veterans” without sounding like the\u00a0commanding officer\u00a0of the 6th Armoured\u00a0PC Brigade; so, with that caveat, I’m going to give it a go…<\/p>\n

I don’t get it.\u00a0 Obviously, if someone is in need of medical attention, I don’t begrudge them it.\u00a0 But it’s hard to see why having been in the forces makes a difference.\u00a0 Being a member of the forces is, in the end, just a matter of having a job of a particular sort; and it’s a job for which you volunteer and get paid.\u00a0 Presumably the risks are clear.\u00a0 To this extent, the same applies to everyone: soldier, Dyno-Rod engineer, philosopher.\u00a0 (Granted, it’s hard to see how anything too awful could happen to a philosopher – “The tests reveal anomalous monism.\u00a0 I’m so terribly<\/em> sorry…” –\u00a0but stick with me.)\u00a0 Obviously, if a soldier is injured, he or she ought to get treatment.\u00a0 But the same applies to everyone.\u00a0 It’s not clear to me why special attention has to be drawn to the needs of veterans in comparison to anyone else.\u00a0 There’s no obvious justification for the special treatment there.<\/p>\n

(The possible reply that members of the forces have made a special contribution and therefore deserve special treatment doesn’t seem to me to be all that powerful.\u00a0 For one thing, as I mentioned, it’s a voluntary job for which people get paid.\u00a0 In other words, becoming a veteran is something you choose.\u00a0 Maybe infantrymen need to be paid more – I don’t know – but the case for that isn’t answered by making provisions in terms of NHS priorities, since that would be inequitable to those who don’t get injured, and it’s not clear that the NHS is the place to remedy allegedly poor pay for some members of the forces anyway.\u00a0 Note, too, that some members of the forces are very well paid indeed, so their claim to priority would presumably evaporate if that were the ground.\u00a0 For another thing, the idea that members of the forces make more of a contribution than you or I would seem to be an empirical claim; I have no idea how you’d measure it, but it’s not self-evident to me.)<\/p>\n

Moreover, a squaddie injured in the course of being a squaddie is already entitled to exactly the same benefits and support as a non-squaddie; it’s hard to\u00a0see why someone born without legs should be expected to cede priority\u00a0just by virtue of never having had the chance to lose them to an IED.\u00a0 Ex-squaddies aren’t any worse off than civvies with comparable problems, and it’s hard to see why they should, on this basis, be given priority.\u00a0 Of course, if a squaddie’s needs are greater than a civvie’s, then that’s straightforward – but, again, being a squaddie makes no difference at all here; it’s the gravity of the need that does the moral work.<\/p>\n

For example, consider the Dyno-Rod engineer who gets a mouthful of sewage while doing his job.\u00a0 It seems odd to say that he ought to go to the front of the queue at A&E because his needs were incurred in the course of an unpleasant job that you or I would rather not have; rather, we’d say that, if he has a pressing need, it’s because he’s just ingested a load of crap.\u00a0 His needs can be assessed without any reference to the mechanism by which they arose.\u00a0 And the same seems to apply to members of the forces, too – unless we accept that they are de facto<\/em> more important, which is exactly the supposition that I’m attacking here.<\/p>\n

And, naturally,\u00a0we might want to say that the benefits and support for any disabled or injured people are insufficient and ought to be bumped up, and that seems fine to me.\u00a0 But the military aspect thereby vanishes.\u00a0 Being a veteran makes no difference.\u00a0 Either you’re treated adequately by the state, or you aren’t.\u00a0 Again, though, the help that the state ought to give seems not to have anything much to do with the process by which your needs arose.<\/p>\n

Bluntly, I don’t see that being a veteran makes any odds at all.\u00a0 But, curiously, on a second reading of the letter, it seems that neither does anyone else.\u00a0 One phrase from the letter stands out:<\/p>\n

… to ensure that military veterans receive priority access to NHS secondary care for any conditions which are likely to be related to their service, subject to the clinical needs of all patients.<\/strong><\/p>\n

…for veterans with conditions related to their service, subject to the clinical needs of others<\/strong>.<\/p><\/blockquote>\n

There’re two ways to read that.\u00a0 The first is that, given two patients with identical needs, one of whom got those needs as a result of being in the forces, merely having been in the forces ought to count in his or her favour when it comes to priority-setting.\u00a0 As I’ve just suggested, that seems arbitrary and unjust at first glance.\u00a0 The other way of reading it is that veterans should get priority treatment unless there’s another candidate for the resources required – in which case, though, we’re talking about a straightforward and workaday problem about priority-setting.\u00a0 Indeed, to say that anyone<\/em> has much of a priority in this sense is to use the word “priority” in a fairly vacuous sense.<\/p>\n

A curious letter indeed…<\/p>\n","protected":false},"excerpt":{"rendered":"

A curious letter was sent out by the Department of Health the other day to GPs and the Chief Executives of various health authorities, trusts, and so on.\u00a0 The full text is available online, but here’s the nub of it: ACCESS TO HEALTH SERVICES FOR MILITARY VETERANS \u2013 PRIORITY TREATMENT The purpose of this letter […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[963,475,577,1544,472],"tags":[],"class_list":["post-248","post","type-post","status-publish","format-standard","hentry","category-curios","category-politics","category-resource","category-the-nhs","category-thinking-aloud"],"yoast_head":"\nParachuting to the Front of the Queue? - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2010\/02\/10\/parachuting-to-the-front-of-the-queue\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Parachuting to the Front of the Queue? - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"A curious letter was sent out by the Department of Health the other day to GPs and the Chief Executives of various health authorities, trusts, and so on.\u00a0 The full text is available online, but here’s the nub of it: ACCESS TO HEALTH SERVICES FOR MILITARY VETERANS \u2013 PRIORITY TREATMENT The purpose of this letter [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/medical-ethics\/2010\/02\/10\/parachuting-to-the-front-of-the-queue\/\" \/>\n<meta property=\"og:site_name\" content=\"Journal of Medical Ethics blog\" \/>\n<meta property=\"article:published_time\" content=\"2010-02-10T12:25:38+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2010-02-10T22:54:30+00:00\" \/>\n<meta name=\"author\" content=\"BMJ\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"BMJ\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"6 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2010\\\/02\\\/10\\\/parachuting-to-the-front-of-the-queue\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2010\\\/02\\\/10\\\/parachuting-to-the-front-of-the-queue\\\/\"},\"author\":{\"name\":\"BMJ\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\"},\"headline\":\"Parachuting to the Front of the Queue?\",\"datePublished\":\"2010-02-10T12:25:38+00:00\",\"dateModified\":\"2010-02-10T22:54:30+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2010\\\/02\\\/10\\\/parachuting-to-the-front-of-the-queue\\\/\"},\"wordCount\":1207,\"commentCount\":21,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#organization\"},\"articleSection\":[\"Curios\",\"Politics\",\"Resource\",\"The NHS\",\"Thinking Aloud\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2010\\\/02\\\/10\\\/parachuting-to-the-front-of-the-queue\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2010\\\/02\\\/10\\\/parachuting-to-the-front-of-the-queue\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2010\\\/02\\\/10\\\/parachuting-to-the-front-of-the-queue\\\/\",\"name\":\"Parachuting to the Front of the Queue? 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