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May 16, 2006

Comments

I am 100% certain that this story is mostly fiction created by the anti-choice site you pulled it from.

It is not worth discussing, and not worth having up, without some credible source providing solid information.

Anti-choice sites are known to mislead and misrepresent this kind of thing all the time.

I presume that katherine wouldn't be thrown in jail for sending pictures of torture victims to Gitmo

Sorry for the small 'jack, but as a matter of fact you can get in big trouble for sending pictures of torture victims to Gitmo. And some folks are in that trouble.

Agree completely on the impropriety of denying medical care on account of boorish behavior.

It appears that he also got 28 days.

How is criminally harassing medical staff a valid political statement?

...to add, would he have gotten his hip replacement if demurred from sending photos via the mail?

Yes. And his political beliefs would remain the same.

He's being punished for bad behaviour, not beliefs.

"It is not worth discussing, and not worth having up, without some credible source providing solid information."

I would normally think that The TimesOnline counted as a credible source. I linked to that.

Use GoogleNews with "Edward Atkinson" as the search term. You will find articles in the same vein from the National Post, The Mirror, The Scotsman, and the Norfolk Eastern Daily Press.

"How is criminally harassing medical staff a valid political statement?"

He posted pictures of aborted fetuses. Annoying. Sure. Criminally harassing? Perhaps in the UK. Worth having your medical care withdrawn? I don't think so.

Query for British readers, are prisoners regularly removed from the lists for medical care?

Criminal harassment or not I have to agree with Sebastian on this one. Slippery slope. I'm not sure what I would suggest as preventive measures against him sending additional materials, but not treating him is wrong.

I don't doubt that the "zero tolerance" policy applies equally to people who insult and grope and stalk the staff, and I suppose folks like that have probably been refused treatments as well, but plain old 28 days in jail seems like the right way to deal with this. And if that's not enough then another 28.

Going to have to agree here. While anti-choice groups and sites (as well as their counterparts in the school prayer/anti-evolution movements) have an established and well-earned reputation for making up crap like this out of whole cloth to bolster their cause, I recall reading about this and think it's probably accurate.

Here's the central question: when is it acceptable for a hospital to deny entry or treatment to someone?

At one extreme, I think it's probably justifiable to deny treatment to someone who has repeatedly threatened and physically assaulted people at the hospital, and who otherwise poses a danger to the staff or other patients.

At the other end, it's clearly not okay for a hospital to deny someone because they don't like the way they look or the opinions they express in the outside world.

So where do you draw the line between a patient's right to treatment and a facility's right to protect its staff?

Here's the central question: when is it acceptable for a hospital to deny entry or treatment to someone?

To many anti-choicers, it's acceptable for a hospital to deny a woman necessary health care, and even to refuse to tell a woman where she can receive the health care she needs.

That sounds very close to government health care discrimination based on the political viewpoint of the patient.

Rubbish. Edward Atkinson was not jailed or fined or denied treatment based on his political views. He was jailed and fined for sending malicious communications (see Malicious Communications Act 1988, after ignoring several warnings to desist his abusive messages to hospital staff. He was denied treatment at that hospital because he had been criminally abusive to staff at that hospital.

Had he simply stood outside the hospital quietly handing out leaflets, a form of protest wholly legal in the UK, he would never have been fined, jailed, or denied treatment.

I'm with Sebastian. Let's suppose, for the sake of argument, that his behavior is so bad that he should be punished for it. Then the appropriate punishment would be to send him to jail, or fine him, or whatever; not to deprive him of medical care. And in fact most codes of medical ethics that I'm familiar with say that your views of a patient are irrelevant to your obligation to treat that patient. When people object to this at all, the objection is usually of the form: but do you have an obligation to treat Hitler if he's been admitted to your hospital? The question 'Do you have an obligation to treat some cantankerous old coot?' is generally taken to be settled in the affirmative.

If I disagree with the war in Iraq, and I send graphic pictures of dead Iraqi children to the families of US servicepeople, I think they would be quite justified morally and legally in procuring a restraining order.

Hip replacement is also for comfort and not for the preservation of life (with the information about this particular individual at hand).

but do you have an obligation to treat Hitler if he's been admitted to your hospital?

Was Hitler harassing the staff?

Think I agree with Jes here.

Sebastian: you link to an op-ed, here is the link to the article from times online.

I've not read a lot about it (and will not start now, it is way past bedtime here), but as I understood it he sent the pictures to administrative staff, not nurses and such, and continued after being warned not to do it anymore. The article I read has allready moved to the paid archives unfortunately.

And Jes: "To many anti-choicers, it's acceptable for a hospital to deny a woman necessary health care, and even to refuse to tell a woman where she can receive the health care she needs."

This is wrong, and it remains wrong even people I agree with do something similar to someone who thinks it's justified.

If the hospital got a restraining order, again, that would be different. It's denying treatment in particular for these sorts of reasons that's wrong.

The reason why medical ethics codes generally come down this way is that they were worked out over a long period, in which doctors had to answer questions like: do you have to treat wounded enemy soldiers on a battlefield? Can you deny someone treatment because he insulted you? Because he voted for a candidate you find objectionable? Because you don't like e.g. his skin color or sexual orientation? In general, the answer that took hold was: you're a doctor first, and your personal views about the merits of your patients are subordinated to that.

(Thus the question about Hitler: the point there is not that he's so very objectionable, but that the world might be better off if he were allowed to die. It's closer to the question: would it ever be OK to kill someone for the greater good? in which, again, Hitler tends to put in an appearance.)

Hilzoy: I'm with Sebastian. Let's suppose, for the sake of argument, that his behavior is so bad that he should be punished for it. Then the appropriate punishment would be to send him to jail, or fine him, or whatever; not to deprive him of medical care.

Hilzoy, if a student has a habit of walking into your office and shouting offensive abuse at you including threats of violence, for which habit the student is eventually banned from campus by the university, would you personally feel you had an obligation to make sure that the student managed to take their exams/do substitute work so that they didn't fail their course because they'd been banned from campus? Since, after all, the student wouldn't have been banned if they hadn't been in the habit of shouting violent abuse at you?

Dutchmarbel, that news article was written before the hospital denied him treatment.

Jesurgislac, is it common practice to deny criminals treatment after their time has been served? Or even while it is being served? I hadn't gotten the impression that denying medical service was part of the UK prison ideal.

"Hilzoy, if a student has a habit of walking into your office and shouting offensive abuse at you including threats of violence"

Jesurgislac, do you have evidence of threats of violence? If not, do you believe that the threats of violence are important to your hypothetical?

If the hospital got a restraining order, again, that would be different. It's denying treatment in particular for these sorts of reasons that's wrong.

I'm sorry, I'm missing something. The hospital is denying this man treatment - except in emergencies - because he has been criminally abusive to hospital staff. You're saying it would be different if the hospital got a restraining order? How would it be different?

"Jesurgislac, is it common practice to deny criminals treatment after their time has been served? Or even while it is being served? I hadn't gotten the impression that denying medical service was part of the UK prison ideal."

I had thought the question was about a particular hospital, not any hospital. Or are you asserting a right to be treated at a particular hospital?

Sebastian: Jesurgislac, do you have evidence of threats of violence? If not, do you believe that the threats of violence are important to your hypothetical?

I confess, I was trying to imagine what would get someone found guilty of criminal speech in the US, since apparently merely sending hate mail is "free speech".

Interesting question. It is important to note that the hospital was still would have treated him had it been "life-threatening conditions” according to the links Sebastian gave. It is also unclear what precisely was sent. If he had sent a picture list titled 'hit list', thereby making the implication that certain staff members were targeted, I think that all of us would agree that he should only be treated if he gets wheeled in unconscious. My question would be did the materials create an implication that staff members were 'targeted' in some way? If so, I think they were well within their rights to refuse to accept him.

How about if student X had plagiarized prof Y's work?

I have a hard time getting even a little worked up over it. Maybe it's just that I feel tired of defending the rights of jerks who'd never return the favor. Let someone less distracted or more dedicated than me take up the cause, and I would contribute to their costs. (In fact, I do that now.)

But I refuse to feel any concern at all that someone who set out to rouse strong emotions succeeded in doing so and then found that he didn't like the result. That's his own damn fault, pretty much. At this stage in my life, I find my sympathy going toward those who're making at least a token effort not to destroy the sort of society I want to live in, the kind of values that my parents worked to establish and protect as their legacy to us, that are in accordance with my sense both of truth and of courtesy.

Now it's quite possible that there are better solutions, like treating him at another hospital. But the point for me is that I can't really muster the passion to care about this, not the way I feel about the fate of people who haven't gone out seeking trouble.

Sebastian: Jesurgislac, is it common practice to deny criminals treatment after their time has been served? Or even while it is being served? I hadn't gotten the impression that denying medical service was part of the UK prison ideal.

It is standard practice in the UK that a doctor may refuse to treat a patient - except in emergencies, of course - if the patient has been abusive to the doctor. That is, if you want your GP to continue to treat you, you do not hurl insults at them in the morning and turn up in their surgery in the afternoon with a hangnail. It is likewise standard practice in the NHS that NHS staff have a right to work without being abused by patients: a patient who is abusive to NHS staff at a particular hospital may be denied all non-emergency treatment at that hospital.

This is the not the case in the US?

Hilzoy: I think you're approaching it from the wrong angle. It sounds like you're weighing the patient's right to treatment against the hospital staff's dislike of the person or distaste for his views. My impression from what I've read--and Jes's clarifications seem to shore this up--is that we're weighing the right to treatment against the well-being of the hospital staff in light of the man's criminal actions.

That alters the equation somewhat significantly. It still makes me uncomfortable, because this is a slippery slope down which religious fundamentalists have already given us a sharp shove, but it does put it in a different light. There are times when a hospital is justified in refusing to admit someone who harasses or endangers the staff, and if that's what he was doing then I have no problem with them refusing his business, as long as they don't turn him away for anything truly life-threatening.

Which they haven't--they're only refusing to provide elective services. Consider the analogy of the doctor in a war who upholds his oath by treating an enemy soldier. Does that doctor's oath obligate him to give the nice enemy a facelift?

I'm going to completely disagree with Bruce though. Doctors shouldn't make decisions based on the patient being a jerk or a proponent of particular political views.

The crime involved makes a big difference in my view.

"I am 100% certain that this story is mostly fiction created by the anti-choice site you pulled it from."

The Times of London?

You might want to reconsider. Because that's a fairly loony thing to say.

Although in fairness, the Times was printing a piece by [email protected], and not one of its own editorialists or reporters.

But while British newspapers tend to be somewhat sloppier than American ones, which are hardly perfect, either, about their facts, it seems unlikely that they'd let such specific statements go by without fact-checking them.

"I had thought the question was about a particular hospital, not any hospital. Or are you asserting a right to be treated at a particular hospital?"

If you take him off a long waiting list even if you let him start at the bottom of a list at some other hospital you have dramatically increased the time to treatment for a very painful condition. And can he even just sign up at a non-local hospital for a wait-list issue? I'm not so sure. Also it appears that he sent the photos (NOT threats of violence) to the administration of the hospital not his own doctor. The administration doesn't do the doctoring, they just authorize to pay for it.

Gary, note that SH linked to two sources. The second apparently an op-ed, so I'm not sure "As reported by" is quite right.

"If you take him off a long waiting list even if you let him start at the bottom of a list at some other hospital you have dramatically increased the time to treatment for a very painful condition."

Are these facts in evidence in this case? And I take it in your comment to Jes you were using "denying medical treatment" to be equivalent to "delaying medical treatment"?

My 7:12 crossed Gary's restatement.

"That sounds very close to government health care discrimination based on the political viewpoint of the patient."

It sounds like the diametric opposite, actually. When the government rations health care, individual hospitals lose the ability to pick and choose who to treat. Surely American hospitals are free to deny non-critical care to, say, the uninsured?

There's a 2003 report on A Safer Place To Work: Protecting NHS Staff From Violence And Aggression (warning: PDF file) which made clear that in many NHS hospitals, violence and aggression by members of the public (physical and non-physical) was going underreported by staff or taken for granted as part of the job. The UK government has been working to achieve a change in that situation where NHS staff know they do not have to simply take abuse from patients as part of the job; where NHS trusts have guidelines on being able to deny abusive patients treatment in the same way as GPs can turn away an abusive patient. (local news reporting)

The story is being twisted by the Times to claim that Atkinson is being denied treatment because of his views.

"I was trying to imagine what would get someone found guilty of criminal speech in the US,"

Violating copyright under certain clear and extreme circumstances (beyond the civil penalty; this is very rare), libel (also unusual, beyond civil suits), but mostly direct incitment to violence, riot, or a direct threat, including specifically and particularly to certain categories of officials.

This is not secret info. HTH.

Also: "Hilzoy, if a student has a habit of walking into your office and shouting offensive abuse at you including threats of violence, for which habit the student is eventually banned from campus by the university, would you personally feel you had an obligation to make sure that the student managed to take their exams/do substitute work so that they didn't fail their course because they'd been banned from campus?"

Hmm. Marking exams.

Operating on someone's hip s.

Nope, no moral distinctions there. Same thing. One's as important as the other. Good analogy.

I also see that there was a long later list of various sources for this story, so obviously it wasn't made up, and so much for "ken's" "I am 100% certain[ty]. Oh, well.

"Are these facts in evidence in this case?"

Since hip replacement surgery has long wait lists in the UK, yes.

Sebastian: And can he even just sign up at a non-local hospital for a wait-list issue?

Yes.

"Now it's quite possible that there are better solutions, like treating him at another hospital. But the point for me is that I can't really muster the passion to care about this, not the way I feel about the fate of people who haven't gone out seeking trouble."

The flip side of that, though, Bruce, are all the people who would say the same thing about anti-war protestors about protestors of any sort for a cause you do believe in.

Although I have to say that given that the guy can presumably go to another hospital for his treatment, this case doesn't strike me as a major issue worth spending much angst on. If the NHS were locking him out, or there was something unique about the care at this one hospital, that would be entirely different.

Gary, I don't really mind them saying that, either.

Maybe it's just that I'm feeling touches of regret over energy that could have gone to supporting people I do agree with, like, and love, that went to bailing out ungrateful scumwads who were busy trying to tear down the sort of society that made their existence possible, on one scale or another. Maybe the society I want would be a little stronger now if so many good people hadn't burned out trying to help those who had no intention of doing their part. Dunno. This is certainly grief talking.

Rilkefan: I don't think doctors should make decisions on my grounds either. I would like to know a lot more about the details of the guy's actions and the relevant laws.

Bruce, I think Jes's links make the matter nearly crystal clear. The only thing yet to be determined is how much of an inconvenience it will be for the guy to go to another hospital and how many minutes he's lost by forfeiting his place on line at an institution he committed a crime against.

I will certainly cop to a plea of skipping the legal judgment in favor of a moral one: I think that people who threaten providers of help and then expect the providers to do them good without taking the harassment into help are ungrateful toads, and whatever entitlement they have to care come from universal claims, not personal ones. They may not automatically remove themselves from the network of social claims, but they certainly shouldn't be surprised when they meet with something less than detached professional calmness.

I don't regard myself as well positioned to know what would constitute justice for this guy. I do regard myself as in a position to say that I'm not impressed by his misery, if any.

Rilkefan: Belated agreement about the merits of Jesurgliac's links.

Jes, notwithstanding threats (which don't seem to be in evidence in this case) I think the point is that providing medical care -- even elective medical care -- automatically burdens you with a high level of ethical obligation.

The question really revolves around whether you consider hip replacement to be a "compassionate" medical treatment, even if it is elective. Not necessarily around how you treat the particular instance of harassment. e.g. imagine for example that Atkinson was treating his local electrical provider this way. Should they be permitted to shut off his power?

If it's the middle of winter and he's going to freeze to death the answer is easy. Otherwise not so easy. But even in summer the balance of power between electrical provider and customer already tilts steeply in favor of the provider, so it seems reasonable to err on the side of caution and favor the customer even when it's not "fair" in the smaller sense. This strikes me as sorta like that -- I think "zero tolerance" policies are no better in British hospitals than they are in US high schools.

OTOH (while I hate to admit it) I find Bruce's argument about people who "set out to rouse strong emotions" strangely compelling. That makes me sad. Gary's rebuttal is great in theory but useless in practice, since we're already in the situation he describes. How fragile we are...

Anders, ouch. That's a legitimate observation, but it's also disturbingly close to being a "two wrongs" argument. We already know that healthcare in the US is horribly broken.

I can imagine fact patterns that would justify Sebastion Holsclaw's outrage, and fact patterns that would justify Jesurgislac's nonchalance.

It's still not clear to me that we have the fact pattern in this case pinned down clearly enough to tell which reaction is appropriate here.

But what's already clear is that this case really has nothing to do with the topic that usual goes under the title of "health care rationing". (Which is a matter of scarcity of resources, cost-benefit analysis, etc. etc.)

And it's equally clear that there is nothing in this story that has any bearing on the desirability/advisability of providing health care to a populace through public or private means, via nationalized medicine, single-payer insurance, PPO's, HMO's, or cash and carry.

There is no government function, no matter how uncontroversially legitimate (even to libertarians!) that could not be withheld from citizens for illegitimate reasons. (Nightwatchman: "call me an ugly git, eh? Then I won't guard you, that's all!")

It's also pretty clear that some people who have an ideological hatred of exploring better means for providing health-care will find any stick with which to beat their private devil.

"Bruce, I think Jes's links make the matter nearly crystal clear."

I don't see how her links help at all. That link doesn't have the specifics of my links, and merely refers to his actions as "abuse" and in violation of a "zero tolerance policy". What the employee's union characterizes as 'abuse' is apparently the sending of photographs of aborted fetuses. So freaking what? These are allegedly medical professionals. They see stuff that gross all the time. And if it was just the administration, double so what? If he sent the photos to Tony Blair I presume you wouldn't think it appropriate to take him off the waiting list. Adding 12-15 months to his treatment time for a very painful condition because he sent some pictures you don't like is ridiculous.

If US Army dentists refused to treat a young man from Afghanistan under their care for a serious root problem that caused enough pain to keep him awake many nights for 12-15 months because he insulted them while treating similarly situated other captives for similar issues, you would correctly call the denial of medical attention and 12-15 month extension of pain "torture". The UK has taken all citizens under their medical umbrella. Prolonging his pain because he sent some ugly pictures is ridiculous.

I should note that I'd feel exactly the same way about someone seeking to give offense in the service of causes much closer to my own heart, though I agree with anyStick about this particular case.

radish: imagine for example that Atkinson was treating his local electrical provider this way. Should they be permitted to shut off his power?

If he is meeting the meter reader with abuse every time the meter reader attempts to enter his dwelling to read the meter, I fear his local electrical provider would, indeed, act to protect their meter reader from abuse. (Especially as the net result of his abuse would be that his local electrical provider would not be able to send him accurate bills.) At a guess, the solution of the electrical company would be: to send round another meter reader; to have installed a Powercard meter, which does not require meter readers to visit; or to require the customer to switch to another electrical provider. If the customer simply continued to refuse to let any employee of any electrical provider into his home without subjecting them to intolerable abuse, yes, eventually he would likely have his electricity cut off - though it would likely take a few years.

It is accepted in the UK that employers have an obligation to protect their employees from abuse, whether that abuse is directed at the employees by other employees or by members of the public. I'm a little disturbed that apparently such is not the case in the US.

"There is no government function, no matter how uncontroversially legitimate (even to libertarians!) that could not be withheld from citizens for illegitimate reasons."

Sure. But government can't withhold what it does not control. Government can't abuse what it does not have. (See for example registries of all phone calls made....)

"Adding 12-15 months" - sorry, where do these #s come from?

"What the employee's union characterizes as 'abuse' is apparently the sending of photographs of aborted fetuses." - uhh, was the guy not sent to jail for his actions - after having been warned? It's not a question of whether I like the pictures or not, it's a question of people enforcing the law and following administrative procedure. All the scare quotes in the world won't change that.

"It is accepted in the UK that employers have an obligation to protect their employees from abuse, whether that abuse is directed at the employees by other employees or by members of the public. I'm a little disturbed that apparently such is not the case in the US."

It is about proportion. It isn't proportionate to move someone off your treatment list (for even a hangnail) for sending photographs of dead fetuses (and I say fetuses because all right minded medical professionals certainly aren't stupid enough to believe they are babies right?) Making start over on a 12-15 month waiting list for painful hip condition isn't in proportion with receiving bloody pictures.

If he sent the photos to Tony Blair I presume you wouldn't think it appropriate to take him off the waiting list.

Certainly not. Tony Blair isn't on the staff of any hospital. The issue is whether someone who is abusive to staff at a hospital can then expect receive non-emergency treatment at that hospital.

"'Adding 12-15 months' - sorry, where do these #s come from?"

That was the wait for hip replacements in the UK according to a recent suit filed against the NHS, though the BBC reported as of May 27, 2004 that the wait was 11 months.

But frankly even if you were to accept the fastest time I could find (3 months) I wouldn't consider that an appropriate punishment for something that warranted less than 29 days in jail.

"That was the wait for hip replacements in the UK"

And where was he on the original hospital's list?


Anyway, no doubt this will encourage people to obey the law in England, much as the awful conditions in US prisons encourage people to obey the law here.

Jes, bearing in mind that anyStick is right about the lack of facts, I don't think that's a corresponding case. If you don't allow the meter reader into your home, you are effectively preventing them from doing their job. Harassing the offices of the utlity does not prevent the meter reader from reading your meter, and does not in fact prevent the meter reader from visiting when you are away, nor does it prevent the utility from sending you the maximum possible bill etc etc.

There is -- generally -- some compromise to be found. And since overall such compromises are far more likely to be unfair to the customer or patient, the instances when they are unfair to the utility or hospital are best silently passed over with a sigh and a shake of the head.

Sebsastian, thank you for that excellent illustrative example. You do realize that sort of thing actually seems to be happening rather frequently, right?

But government can't withhold what it does not control. Government can't abuse what it does not have. (See for example registries of all phone calls made....)

I don't understand. Are you saying that the government already had legitimate access those records? Because if not then you are giving an example of what you say does not exist: the govt got what it did not have and abused it quite effectively thankyouverymuch. Rule of law notwithstanding.

I have to say that I'm surprised at the amount of debate this is generating. Yes, the guy was being an insensetive and rude idiot, but one of the things that comes with a society in which morality is not legislated for is that people have the right to be insensitive rude idiots, and they have the right to enjoy basic services despite that.

Some of the most moving stories I've read in recent times involve abortion clinic staff treating, with sensitivity and confidentiality, women who stood on the steps of their own abortion clinics, threatening them, and returned to do the same thing the day after their abortion. This is what the English staff should have done, irrespective of what their law says.

Surely even if the actions he took were illegal, denial of medical care does not form part of the legal punishment for his actions. If this is the case, he should not be denied medical care. It's as simple as that.

(To look at it from a different angle - if Hilzoy and Seb agree there's probably a strong case being made!)

"Yes, the guy was being an insensetive and rude idiot"

To my mind, the point is that the guy was being a criminal.

Jes, I don't see how excluding Atkinson from the hospital comes under "protecting staff". The staff he abused were people in the administrative office, not the ones who would be treating him. It looks a lot more like punishing Atkinson than protecting anyone.

Still, I find it hard to rate this case very high on my long list of things to be outraged about at the moment. I guess Sebastian thinks it contains an important lesson, but like anyStick I don't see it.

Jes: "You're saying it would be different if the hospital got a restraining order? How would it be different?"

The idea was that this should have a legal solution, or else a personal one (e.g., staff not wanting to go out for drinks with the guy), but not one undertaken by medical staff in the performance of their duties. I think that's wrong. And I don't think that mailing pictures constitutes a threat from which people so badly need to be protected that they should stop doing their jobs.

I agree with Bruce about this person having no real right to complain. But I think it's not about his consistency, but about the values by which medical professionals should govern themselves.

"To my mind, the point is that the guy was being a criminal."

Is being denied medical care considered a legitimate punishment for criminals in the UK? I suspect not.

I'll confess to another bias here, about health care stories in particular.

I've been drifting in the direction of support for universal health care for a long time, and been there pretty solidly for some time now. But seeing what's involved in quality end-of-life care for my father has really radicalized me on the subject. Dad has the benefits of being a veteran, and a NASA employee, and by virtue of working at Jet Propulsion Labs coverage through TIAA/CREF, since Caltech administers JPL. He's as well set as someone a quintile down from the top can be, pretty much. Even so there are difficult choices involved.

The thought of what those who happen to lack Dad's advantages must go through at this final stage of life, they and their families, occasionally punches me in the gut, almost literally. It's not that - from a detached viewpoint - this is news, really. It's not radically unlike the problems facing, say, me with my chronic health problems, or Gary with his, and our counterparts up and down the ladder. It's just that it is the final stage of this life, with no room for later redress, and something that will inevitably linger in the survivors' minds.

So an argument that amounts to "poorer people don't deserve dignified deaths because see, sometimes overzealous officials might make life difficult for jerks" is hard for me to process. This story is not a useful datum in any meaningful discussion of health care - not least because such things also happen all the time in the private world, and often with less prospect of redress. So it chafes me extra.

"Is being denied medical care considered a legitimate punishment for criminals in the UK?"

Having tried to clarify this point above, I think you're confused about the meaning of "deny".

I should add:

I will not feel any quarrel with someone who wants to say, "Bruce, you're just too emotionally unstable about it right now" and declines to talk about it with me. I am unstable, I admit it, I'm not always handling my grief very well. I'm quite comfortable being a datum in someone else's argument.

"To look at it from a different angle - if Hilzoy and Seb agree there's probably a strong case being made!"

Made up fact of the day:

53% of people who wish for a paralyzed government think that Hilzoy and I should be dictators by unanimous consent.

"Having tried to clarify this point above, I think you're confused about the meaning of "deny"."

I'm really not. When a pharmacist denies filling a prescription for RU-486 is it less of a denial when the woman can get it elsewhere? That pharmacist still denied the distribution of the drug. The public hospital is denying care in this case. Furthermore, unlike in the pharmacist case, they are noticeably setting back the timeline on the care.

"This story is not a useful datum in any meaningful discussion of health care"

Oh, come, Bruce--that's not true at all. Why just last week it turned out that one of the counter-guys at our local post office was looking into people's mail sometimes.

Abolish the Post Office! It's a bastion of socialism! Government can't abuse the mail if government doesn't handle the mail!

Furthermore, last month I read that there was this guy at a toll-booth who would sometimes wave his friends through without paying.

Abolish the post roads! More socialism! Government can't abuse the roads if government doesn't build any roads!

And the worst thing about these socialist intrusions into the free market? They were illicitly smuggled into the Constitution! By Socialists! The Socialists even smuggled in a line about "promoting the general Welfare"--boy, doesn't *that* just burn your britches!

FWIW, there's a little more to the fact pattern than either the anti-choice sites or the TimesOnLine op-ed mentioned: Mr. Atkinson sent the offensive materials more than once, sent a video as well as the articles, and continued to send the stuff after the hospital wrote to him requesting that he stop. So that makes it a harrassment campaign, not a single incident.

But I can't agree with the hospital refusing to do the hip replacement, even if he could have it done at another hospital without going through another waiting list.

Here in the good old USA, pharmacists are refusing to fill prescriptions that they say offend their religious and/or moral beliefs. They have refused to fill morning-after birth control scrips, regular birth control scrips, and I think there's been one case of a pharmacist refusing to fill an antibiotic scrip because he thought it was for treating an STD.

My reaction to that is quite straightforward: pharmacists who refuse to fill prescriptions on religious/moral grounds should be fired, have their pharmacist licenses revoked, be heavily fined for practising medicine without a license, and be sued for malpractice.

Telling someone they can fill the scrip elsewhere is putting an undue burden on them.

It seems to me the same principles apply in Atkinson's case.

It isn't quite the same, since he harrassed the hospital, but the basic principle holds: people who provide healthcare should damned well provide it, and not put undue burdens on people needing medical care out of personal distaste for the procedure or for the patient.

The only justifiable grounds for refusing to treat someone would be if s/he threatened physical harm. SFAIK, Atkinson didn't threaten anyone.

A pharmacist refusing to follow the rules and regulations of his profession by denying service because of superstition is not comparable to a hospital following proper procedures to safeguard its employees from those who have acted criminally against it.

I'm with the NHS on this one.

Note that he wasn't put on probation or sentenced to community service, but jailed. That alone implies that there's something we're not hearing here, since you generally have to be pretty obnoxious to get jail time for harassment instead of something that's cheaper.

Given that he was jailed for the way he treated the hospital staff, I'd think it's perfectly reasonable to say that they shouldn't be forced to treat him for non life-threatening conditions. He does have alternatives after all, unlike an enemy soldier in wartime. Maybe having to live with the consequences of his actions will make him think twice the next time he decides to get criminally abusive.

Sebastion, you seem to not quite understand how a "waiting list" for hospital procedures work.

It is NOT an ordinary queue, set as first come/first serve. All other factors being EQUAL, the first in line will go first -- but hospitals treat the patient with the most urgent problems first, regardless of when they first sought treatment.

In short, this man's wait will have far more to do with the severity of his hip problems than with what hospital he choose to have it done at.

I suggest you adjust your argument to account for that. Citing a "12 to 15 month wait for hip surgery" as if it were a wait in line for tickets is quite simply false. Those who wait that long -- or longer -- are generally being treated for conditions that are stable and can be controlled (but not rectified) by other means.

I don't happen to agree with you in this case: This hospital denied him non-emergency services. In America, this is done routinely -- from reasons ranging from harassment to inability to pay. As there are plenty of other hospitals in the UK, and he's not joining the end of a 12 month queue -- he will be joining a relative handful of other individuals with his severity of hip problems.

rilkefan, I agree with your point; I just don't know that Atkinson crossed the line to criminal behavior. "Jailed for harrassment" isn't the same as "physically threatened hospital staff and/or damaged hospital property."

If it turns out Atkinson's harrassment went beyond sending inflammatory mailings, if it turns out he did threaten people, then I have no problem with the hospital saying it wouldn't treat him.

I have to say, that though I dislike the English legal system's approach to speech, if I worked at a lab in England and some crank kept sending offensive materials to the admin staff because he's upset at my work to the point that he finally ended up doing time, I would feel acutely uncomfortable passing him in the hall.

I think I would feel better about the entire thing if the hospital were required to obtain a court order. They might well be entitled to obtain one; but I think the courts would do a better job of ensuring that no one's right to receive medical treatment is unduly infringed.

It isn't proportionate to move someone off your treatment list (for even a hangnail) for sending photographs of dead fetuses (and I say fetuses because all right minded medical professionals certainly aren't stupid enough to believe they are babies right?)

We really don't know precisely what post it note was attached to the images, or how Atkinson expressed himself, but if someone sent me photos of surgical procedures unbidden and I specifically requested that he stop, I would have the strong presumption that he was not trying to expand my factual knowledge base. I've worked with doctors here (at my last university, I set up a medical English course and did proofreading for a journal published there), I didn't notice the doctors getting packets of snaps of operating procedures in the mail. If he got jailed for without the warning, I'd be a bit concerned, but when someone gets warned, it means that they should stop.

As for court orders and such, I imagine that the UK courts operate on a different system, and they have had a bit problem with the notion of court orders, as the wikipedia entry on asbo suggests, but links to the local paper are here and here

have this

Mr Atkinson, of Ely Road, was also made subject to a five-year anti-social behaviour order (ASBO), and told he would have £500 court costs deducted from his benefits. The hospital has barred him from treatment for anything other than life-threatening illnesses.

RF, maybe so, but I'd hope that if you were a medical professional you wouldn't refuse to treat people just because you felt acutely uncomfortable around them.

Sebastian: That sounds very close to government health care discrimination based on the political viewpoint of the patient.

As bad or worse, I would say, as private health care discrimination based on the economic position of the patient.

Either some background is missing here, or someone went beyond their authority.

According to this (pdf), there are specific procedures to follow before denying treatment.

Apparently, loud and intrusive conversation is considered to be non-physical assault.

KC, depends on whether "acutely uncomfortable" translates to "wet socks" or "fear for my life".

I just don't know that Atkinson crossed the line to criminal behavior.

He was jailed for 28 days.

I'd hope that if you were a medical professional you wouldn't refuse to treat people just because you felt acutely uncomfortable around them.

Well, if I was a medical professional I certainly would hesitate to deny an optional treatment to a person who was threatening me.

Is there no place in this debate for Mr Atkinson assuming personal responsibility for his actions?

I don't know if it's been posted yet, but here is the NHS's Zero Tolerance Policy.

Who was threatening?

I certainly would

That should read "wouldn't"

"Who was threatening?"

That would presumably be the criminal in the case.

Why would you presume that? The reports said that he sent images of post-abortion fetuses that the made the staff upset and "quite disturbed". That isn't the same as "threatening" at all.

Usually people feel threatened when they are the victims of crimes. In any case I was interpreting spartikus's comment, since I found it clear enough to jump in.

When UK med staff "feel threatened," a guy gets his care postponed.

When NYC cops, "feel threatened," an unarmed guy gets gunned down.

I don't much care who "feels" threatened.

Are we now playing the game where Sebastian claims not to be aware of some common category (in this case, the suite of crimes that includes stalking and harassment) and we all act like this is some purely innocent ignorance to be remedied by patient lecturing until the whole thing collapses and we never get back to the original point? Just checking.

For those who actually don't know, the Wikipedia entry on stalking is pretty useful, and handy for discussing the concepts that drive lawmaking about it more than particular statutes.

I thought this was the game where we pretend SH isn't smarter than us and we can argue with him about legal issues because he's not dispassionate enough to be unassailable.

Dammit. I was hoping this was the game where we'd all pretend to be grown-ups and then spin the bottle. Oh well.

I have this nice bottle of Knudsen's sparkling raspberry juice that I'd be happy to spin.

That isn't the same as "threatening" at all.

Ah, so you've talked to Atkinson and know his intent.

spartikus, thanks for the NHS link. If they followed those procedures and Atkinson signed the letter, I'm not sure how he would have any grounds for complaint.

As for excessive noise, this is a hospital where people are trying to recover. If I or a loved one were in a place where someone didn't have enough respect to pipe down after being asked once, I would be pretty cheesed if I were told that they were just exercising their rights to free speech.

champagne bottles spin very well.

somehow i've always believed that hilzoy, jackmormon, lj and jesurgislac are all hotter than than the sun on a clear summer day.

[yes, i'm married, and happily so. yes, i'm aware that jes is gay and likely would not find playing spin the bottle with me to be her life's passion. {although a lot of people seem to think i'm female -- i get a lot of mail addressed to Ms. Frances ...} no, i don't think there is anything wrong with a fantasy or two so long as no one gets hurt. yes, i'm threadjacking.]

sparkling raspberry juice? ye gods, man, did someone blowtorch your taste buds? try a nice dry Normandy cider.

oh, back on topic .... i don't believe that the criminal justice system should be able to include deprivation of medical procedures as a method of punishment. if this guy's criminal conduct was so offensive to hospital staff that they feel that they cannot treat him fairly, then the hospital should arrange for another hospital to take him at the same time as he would have received treatment.

Francis: Alcohol is among the many, many, many things I'm severely allergic to. If it's more than about 10 proof, I can't touch it.

"yes, i'm married, and happily so. yes, i'm aware that jes is gay and likely would not find playing spin the bottle with me to be her life's passion. {although a lot of people seem to think i'm female -- i get a lot of mail addressed to Ms. Frances ...} no, i don't think there is anything wrong with a fantasy or two so long as no one gets hurt. yes, i'm threadjacking."

You might be surprised by how hot LJ is.

Jes, I don't see how excluding Atkinson from the hospital comes under "protecting staff". The staff he abused were people in the administrative office, not the ones who would be treating him.

Actually, he sent mail to at least one of the nurses, as well - according to one of the news stories about the case I was looking at last night.

Further, NHS policy is that all staff at a hospital deserve to be protected from abuse, not just the medical staff.

Actually (reading comments posted since) it would appear that Hilzoy and Sebastian have both decided that Atkinson's abuse of hospital staff was not bad enough to justify his being excluded from that hospital. In Sebastian's case this appears to be because he thinks that no one should be upset by pictures of aborted fetuses, and especially not hospital staff: in Hilzoy's case, because she thinks that getting sent offensive/upsetting pictures through the post is not sufficiently upsetting to justify being protected from more personal abuse by the sender.

(So, Hilzoy, if a student were persistently sending you and other staff pictures he intended you to find offensive/upsetting, you would protest the student being banned from campus, on the grounds that if he were banned from campus you couldn't do your job of educating him?)

Francis: if this guy's criminal conduct was so offensive to hospital staff that they feel that they cannot treat him fairly, then the hospital should arrange for another hospital to take him at the same time as he would have received treatment.

Well, yes. And indeed, allowing for a small amount of bureaucratic delay in getting himself on to the list at another hospital, that's exactly what will happen. Ted Atkinson is not being denied treatment - end of story: he's being denied an appointment for assessment for a hip replacement at the hospital he was harassing. He'll have to go to another hospital.

You might be surprised by how hot LJ is.

I'll never know given how he ditched me :(

This man is a convicted criminal. Convicted criminal.

These people are his victims. His victims.

You are saying that the victims of a criminal should be forced to perform non-essential surgery on him, while there are other perfectly good alternatives avilable. You can't seriously hold that position.

If, say, this was the only hospital in England capable of performing the exact life-saving surgery that the man needed in 24 hours time to save his life, then, yes, they should treat him. Guess what? They would. They'd even treat him if he had a life threatening condition that other hospitals were capable of dealing with.

What the man's criminal speech was is irrelevant. It was, in the eyes of the English law, sufficent to warrant a month long stay in HM's Prisons. That is where he violated the hospital's zero tolerance policy.

He isn't being denied treatment at that hospital for his political speech; he is being denied treatment at that particular hospital for commiting criminal acts against its employees. He isn't being denied treatment completely either. He won't be able to receive that treatment at the place of his choosing.

You know, a criminal being forced to go to a different hospital from that which he victimised, to receive a non-essential treatment, with the assurance that, in the event of any life-threatening emergency he'll be treated at the original hospital, really doesn't strike me as at all political, or even all that bad.

By the way, the US rations healthcare too. And, because it does it by means of money, and, if you make the right political choices and therefore place yourself in a position to take advantage of graft, corruption, etc, then you, as a society, will have rationed it politically. It is quite easy to argue that every person in the US who has benefited from the various political patronage systems in place in the US has had their healthcare ration based on their political activities, just as much as this guy.

Whether the rationing is done by society through the market, or more directly through the government, it is still rationing by society.

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