Healthcare, Ethics, & Postmodernism | Philosophy Tube
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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. is where you can
voluntarily distribute some of your resources to help us afford things like food and rent.
Or, is where you could make a one-time donation. And don’t forget to subscribe.

About Bill McCormick

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100 thoughts on “Healthcare, Ethics, & Postmodernism | Philosophy Tube

  1. I feel like whether or not pregnant women would receive treatment would depend on your opinion on when the life of the child begins, since in theory they did not choose to be conceived – but, then, do they gain healthcare rights at conception or birth?

  2. Although… you can’t say that every pregnant person is responsible for their pregnancy. And why would every type of cancer need to be fixed before, when some cancer patients definitely are responsible for their situation. Hmm…

  3. My significant other's in the UK. He has a severe mental illness, very hard to treat.
    I found out that the NHS mental health services has the same levels of calls for service as the medical side of the service, but has 20% of the funding.

    I put this down to mental health stigma. People blame the mentally ill for their conditions on some level.

  4. Well I think you make it a bit easy for yourself. It is true, that we cant apply this theory to its fullest intent in practice, but on the other hand, wich theory can be applied to its fullest?
    Take the taxes for example. To is not easy to masure income and to tell how much is owed to the socety. And that is compareably easy! How should and philosophy be in charge of fully and fairly distributing medical recources?

    I think everyone who is smoking is putting himself deliberatly at risk and if is not a lifestyle choice like having sex or something like that. Same with people who are obesed without medical reasons.
    I am not saying let them die. I am saying let them pay more for healthcare. Maybe get a lower priorities for organ doners, if the condition is related to that problem. They won’t have to wait until everyone is cured, but they have to feel the consequences of their actions and I think in that way we could encourage people to treat themselves better.

  5. I'm overweight, and have only been gaining more because of my chronic pain and fatigue, bulimia, depression, anxiety, OCD, and CPTSD. I regularily exercise and eat healthy. But when everyone hates you because you "look bad" it kind of just hits the point where you might as well just give up. And for me that's always, should I just fucking kill myself or eat myself into a stupor and become a homeless drunk? Neither hopefully. But when you constantly hate yourself it's hard to better yourself.

  6. Also, the state allows smoking because of the sweet tax money and allows advertising which tells kids smoking is cool. If you say not with my taxes. well the smoker has also paid a lot of taxes. Tabaco is quite cheap without the taxes.

  7. I wonder if I would have been able to get surgery if personal responsibility was in the question. I had a deviated septum. It was something I lived with forever. I was in so much pain. My face was in agony. I couldn’t breathe through my nose at all. I couldn’t focus or go about my day to day life because of how little sleep I was getting because I couldn’t use my nose. On top of that, my allergies seemed to steadily be getting worse and worse. However my septum became deviated because I broke it when I was 6 years old. I could still breathe through my mouth and I wasn’t suffocating or anything. I didn’t even realize it was that bad until I got my septum fixed. I went into the doctor for a sinus infection and learned that face guts were seriously messed up.
    I’m glad I had surgery. It was expensive as hell even with insurance. But I wonder if the people who say smokers shouldn’t get new lungs would say I shouldn’t get my face fixed

  8. What about runners who blow out their knees, or other athletes who get sprains and breaks? Who decides how much drinking disqualifies you for liver transplant? Or smoking for that matter. If you smoked for a year in your twenties, are you disqualified? If you work a job in a kitchen, is it your responsibility if you get cut or burned?
    Just some thoughts on "responsibility"

  9. This is why humans aren't robots, because any set of guidelines needs to be flexible. The principle of voluntary responsibility works perfectly well as a starting point, as a factor in the discussion, but obviously situations that are immediate or easy to fix would raise in precedence relative to things that are non-critical or massively complicated. You wouldn't have to set ALL voluntary concerns aside until ALL cancer is dealt with, you'd just consider that all else being roughly equivalent, the naturally occurring condition would take precedence over the self-inflicted ones.

  10. This makes me think of the 'self driving car' problem with comparing risks of hurting/killing people. In an outline released, fat people, elderly people, and homeless people were deemed less worthy of living and were put more at risk. Really scary thing.. also thanks for shouting out kivan!! He's got a great twitter

  11. As a Peterson fan I laughed at the well made joke. Also because I don't think Peterson's real problem lies with the observations and critiques of the post-modernists (which he stated multiple times), but rather that those ideas lead to intellectually lazy spoiled brats who use it to only get the nice things without the necessary responsibility that comes along with it.

  12. Its the best shot at equal opportunity when you agnowlrdge that its unliket thst corruption will never truely disappear. So its the best possible system.

  13. Smoking delays healing which could lead to a dehiscence which could lead to post-infection which could lead to loss of transplant… minimizing post op complications is ethical.

  14. In america if we had the same health care system our debate would sound more like this "black people are more likely to be shot so why would we give them prefered treatment"

    btw i bwlive this is a decent representation of a conservative argument under these circumstances because concervatives already argue that blacks are more likely to be involved in gun violence purely of thwir own volition, ignoring the fact that it legitimately means black people get shot because they are black. I know im trailing but ive had a symilar debate 3 times this month with the same people 1 of which it came down to black people are black and thats the problem.

  15. You're responsible for car crashes because you know the risk when you get in the car. There's one extreme. Or even when you get robbed in your own house. You're responsible because you know there's a chance, it's just unreasonable because of the cost of trying to avoid it. You're also responsible for literally anything that could happen to you, because you made the decision to keep living.

  16. i subscribe to a highly utilitarian view when it comes to limited resources (and I mean truly limited, we can't get more organs until we've figured out a way to grow them, and fundamentally if we aren't going to force people to become doctors, we also have to deal with that shortage (yay 3 different GPs since the one I had my whole life retired two years ago!) there will be other genuine shortages, maybe a meltdown happens at a medical nuclear isotope factory (that happened in Canada a few years ago) that severely limits the availability of those types of imaging tests, or maybe the facility where a certain drug is manufactured burns down, and there will be a limit in availability before new equipment is made. I think we can aim for full coverage, but we also have to recognise there will be instances where something happens and resources become limited. I think in those instances we maximise benefit. People who can wait wait, and people who can't are prioritised, a younger person who will get more years out of a new organ will be put ahead of an older person who is less likely to. I think it's hard to make those judgements, and in all cases there should be oversight and a procedure that is publicly available and debated.

    The thing for me though with the personal responsibility is that I fundamentally don't believe it is a personal responsibility, it is always societal responsibility. If someone has an unhealthy diet it is because society has somehow made that better than a healthy one, maybe they live in a food desert, maybe they don't know how to cook maybe they can't cook because of health conditions, regardless these issues are society's failing. Likewise, let's look at a person who has been smoking 40 years, the reasons they smoke is either because they became addicted before cigarettes were known to be harmful, in which case it's partly on chance for the lack of knowledge, and partly on society for the resources to quit being unavailable or uneffective. If it is a person who started knowing the risks, than it is society's responsibility for why they ignored those risks, did they have untreated stress that they turned to tobacco to control (most of my friends here in Ireland started smoking during their Junior Cert or Leaving Cert,) is it something they picked up from their parents who were not given adequate resources to quit? Were they in an unsafe home and smoking because they felt no regard for consequences along the line, (most of my friends in Canada were in that camp, if you're not going to be alive in 20 years why care if you might get cancer or a stroke then) in which case it is society on not giving them adequate care, not taking them out of unsafe homes, or providing their parents with the resources to be able to care for their children. It's on society for creating a situation where people in certain demographics think that their life isn't worth it.

    Fundamentally I don't agree in personal responsibility because I don't agree that a person who is healthy will harm themselves (speaking as a person who has harmed myself) and so not only are we as a society responsible to help people who are sick, we're also responsible (and this goes beyond healthcare a lot of this delves into housing and education and representation and food availability) for making a society where certain illnesses happen due to circumstance.

  17. The first thing that comes to mind when I hear denying people health care based on their responsibility for their conditions is the just world fallacy: the idea that every bad thing that ever happens to anyone is deserved, with the only evidence being that the bad thing has happened. Following this, anyone who doesn't conform to the desires of the people making the decision is screwed, like gay people during the aids epidemic. For maximum irony, take someone who grew up in a poor neighborhood with massive lead poisoning. This person gets injured in a fight, breaking their leg. How does the NHS respond?

  18. Yeah that's pretty disgusting.. how about we punish and dismantle the tobacco industry instead of patients? Just a thought.

  19. The reason capitalism doesn't really give you choice is because you can't choose if you're dead thanks to capitalism.

  20. Ted is right, public healthcare does put people's lives in the hands of the government, which is arguably no ideal.
    The alternative however, is putting the people's lives in the hands of rich capitalist billionairs, which is unbelievably much worse.

  21. Seems like a closely related topic to “fault” and “deserving”. Many people point to these ideas to justify policy or action, but when you dig deeper they seem to often fall apart.

  22. Wish he would've addressed the organ donation topic more thoroughly, in extreme scarcity I feel like utilitarian approach is the only viable one, despite its flaws. Also a major limitation of the study he quotes, aside from the low power as he mentions, is it is on prospective jurors (aka an example of the general population) and while it is probably somewhat transferable to medical members of a organ allocation organization such as UNOS, as they are all humans with biases themselves (not to mention capable of manipulation by elites a la Steve Jobs or Micky Mantle) it is most certainly a difference in perspective/education. Ideally with advancements in IPS cells/cellular scaffolding we can will organs into existence in the near future but that won't answer the question currently. Who will get the most good from an organ, lowest morbidity/mortality, seems like the only way to guarantee adequate allocation and unfortunately that is highly dependent on comorbidities, be they genetic or socially induced, and while it is uncomfortable those scales need to be weighed I fear at least for the time being. Another interested subject related to the study he quotes is the manipulation of the media/population at large to give organs to "deserving" pts as seen by Sarah Murnaghan where her family successfully pressured UNOS, via social outrage and the local government, into allocating her a lung transplant despite it being against UNOS policies aimed at utilitarian allocation of organs, though the argument could be made that these were flawed though her outcome was poor seemingly validating UNOS concerns albeit anecdotally. Bit of a garbled mess of a comment probably but hopefully understandable. Very interesting topic and obviously difficult to cover within time constraints, hopefully this did not come off as hypercritical as I am no philosopher and may very well be talking out of my ass. Very much enjoy your channel and the video though!

  23. That surgeon quote is hilarious, I'd expect that type of humor from an EMT. always forget what little smiling sociopath surgeons are also. MUAHAHAH BLOOOOOOOD!! Bet they have some fun sexual appetites…

  24. Also the standards for fat are very low in asian countries ive visited. Most healthy adults in the EU would pass as fat for sure.

  25. If a personal choice led to them getting sick, then that patient usually already needs to prove to their doctor that they've changed their behavior. It shows that they're making a huge effort and that they're working with the doctors to correct their health issues.

    You can't have someone with drug-related cirrhosis getting a liver transplant and then destroying it a year later from drug use; there are good reasons why doctors would deny an uncompromising patient when there is limited resources. That cystic fibrosis patient still has to be mindful of their behaviors — not smoking, not being around sick people with their immunosuppressant drugs, etc — so it seems pretty fair to make a smoker quit to maximize the benefit they'll get.

  26. The strongest argument against the idea of voluntary responsibility is our lack of libertarian free will

  27. Voluntary choice is not the same as informed voluntary choice ie someone who unwittingly gets an STD vs a smoker
    Otherwise good video

  28. Interesting discussion (as always) reminds me of a study done recently on how differently Drs responded to pain felt by men & women. Men’s pain was acknowledged and medicated while women were often believed to be exaggerating, whining or hysterical and therefore given no pain relief. Another looked at how differently men & women who suffered heart attacks were treated – women were often sent home, some to die there, while men were treated aggressively with medication & surgical procedures. The result of this is that statistically women are far more likely to die of a heart attack than men – here in Australia anyway.
    Personally, when I was hospitalised for self harming the Drs very clearly communicated to me their disgust & that I was wasting their time when they could be spending it on “more deserving” patients. The value judgement that mental illness is not a legitimate illness is fairly pervasive.
    Love your work Olly ❤️

  29. "We have deserving and undeserving patients".

    Are you serious? How is that not exactly the same thing as a death panel?

  30. just a random thought:

    Under neoliberalism, one really only exists as an economic entity.

    Therefore, one exists and has power in proportion to the degree that one has money. The more money, the more power.

    And truly economically broke people aren't within a neoliberal's definition of human.

    They don't exist as humans, they are things.
    So the neoliberal is justified in not caring about them, in their philosophy.
    They have no economic existence, therefore their existence has no validity.

    Just posing that and considering it…

  31. I'm pretty sure Peterson himself (!) talks at length about how facts only exist in the contexts in which they matter – in maybe lecture 3 or 4 of one of the series that start by discussing Pinnocchio. It had to do with how the world of humans isn't a world of matter etc., but one of other humans, utility and context.

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

  33. 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

  34. 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.

  35. 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.

  36. 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.

  37. 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.

  38. 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.

  39. Calling neoliberalism ‘individualistic’ and ‘pro-free market’ is like calling modern day China communist.
    Neoliberal societies only provide individual choices when the state allows it. They only provide free markets, when the state allows it.
    I would argue that this happens very rarily, but that is all a matter of historical and potential perspective. I would like to argue that any right that is not universal and cannot be changed or bent by an elite class of people, is not a right, but rather a privilege, and there can be no such thing as an individualist privilege, because these privileges are not given, and therefore not individualistic. Enforced freedom is the biggest oxymoron, that a whole of people seem to believe to be real.
    I would go as far as to say capitalism cannot be compatible with a free market, as one requires property rights and the other requires its abolition.

    I guess political terms only mean whatever the person saying them wants them to mean.

  40. It is extremely ridiculous to say that the NHS would be able to treat everyone, more than they treat everyone now. I’d argue that perception of health is relative and there essentially is no difference in the health of anyone. If it became possible to measure health in a sort of HU (health unit), and the NHS were able to elavate everybody’s HU score with 10 points, the person with 90 points would still be unhealthy compared to the person with 100 points. If then the NHS managed to equalize everybody’s HU to 100, the person who with 100 HU, though capable through the treatment to have it increased to 110 would have to be ignored treatment, because his treatment would make everyone else unhealthy. This is why aiming for equality is ridiculous as it just ends up lowering everyone’s situation, because that’s the easiest option.

    Furthermore, an argument could be made, that if you were to seize all empty homes in order to end homelessness, you would make everybody homeless. If the current rights of personal property were to be violated, by taking what is considered to be someone else’s property, everybody essentially loses the right of owning their own home. If the state was allowed to take any house it wished to, would all houses then not subsequently become the property of the state? Sure we would all have a house to situate ourselves in, but then all homeless people are freed from their homelessness the second they step into a house, whether it’d be a 7/11 or a train station.

  41. 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)

  42. 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.

  43. 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.

  44. 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.

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

  46. "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.

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

  48. 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.

  49. 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 🙂

  50. 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???

  51. 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.

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

  53. 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

  54. 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.

  55. "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.

  56. 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.

  57. 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.

  58. 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?

  59. 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?

  60. 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.

  61. 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!

  62. 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.

  63. 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.

  64. 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

  65. 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.

  66. 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.)

  67. 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.

  68. 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.

  69. 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?

  70. 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.

  71. 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.

  72. 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.

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

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

  75. 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.

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