Michal Pruski
University of Manchester
Dear Editor, It is the responsibility of healthcare professionals to present patients with the available options for managing their conditions, including the potential benefits and anticipated negative consequences of each option. Patients then weigh the potential benefits and drawbacks of each option, and juxtapose them with their wider life goals and preferences. We generally accept that patients might not choose the option that is most health or life preserving because they might value other things more. We accept that forms of cancer treatment that might only minimally extend life are not always a reasonable choice or that a patient might chose not to wish to have CPR performed if they suffer a cardiac arrest. While all people tend to value health to some extent some might value friendship and family life over their health. Of course, having good health helps with having fulfilling relationships with others, but often it is having these relationships is the primary goal of tending to one's health. If you are elderly and might die soon anyway, you might wish to take the risk of meeting others and dying sooner over living longer and potentially not meeting anyone. Not everyone values the same basic goods of life (e.g. as presented by New Natural Law theorists) to the same extent. Governments need to balance how they prioritise these goods, which is very difficult, especially in a liberal and pluralistic society which largely tries to refrain from making judgments on how to prioritise such goods. The authors of the original article have rightly highlighted the potential consequences of the Christmas relaxation of the lockdown measures (which relaxation has now been cancelled). Yet, we should simultaneously not expect governments and citizens to make decisions based on their consequences on the NHS and people's health. Health is a good, but not the only, or even supreme, good. Liberty, friendship and family are other goods. People also need to have hope to live their lives well, and governments need to be trusted if people are to obey them. It is not clear that the general mood in society following the cancellation of the Christmas relaxations will not have graver consequences than the original relaxation would have - this is anyone's guess. But it would not be irrational for the government to allow these relaxations - it would simply not have aimed at maximising the benefit to the NHS and people's health. We would not expect patients to always act to maximise their health, why would we necessarily expect the government to do it - it did not get voted in solely on the basis of their health policies. Why we might wish people and governments to promote health in general, we should not be surprised if they make decisions where they balance different goods and not just maximise health. This might not be generally helpful to us as healthcare professionals, but it is neither irrational nor is it different how we often make decisions in our personal lives.
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