SMOKERS, drinkers and the seriously overweight may be denied medical treatment if their lifestyle makes it ineffective, the Government’s treatment watchdog said yesterday.

The National Institute for Health and Clinical Excellence (NICE) said that doctors who considered that a particular treatment might not be effective, or cost-effective, because of the lifestyle of the patient, may be entitled to withhold it.

However, doctors should not discriminate on the ground that a disease was self-inflicted. Even those who had brought their problems on themselves deserved treatment.

It makes clear, to the delight of campaigners, that discrimination on the ground of age alone is equally unacceptable. However, when a patient’s age affects the chances that a treatment will work, it can be taken into account.

The new guidance seems certain to be cited in cases such as the recent ruling by three primary care trusts in East Suffolk that obese patients could not have hip or knee transplants. The trusts were widely criticised, but could now use the NICE guidance in their defence — arguing that operations are less safe for the obese, and that for such patients hip and knee implants are less effective as they wear out sooner.

The guidance could also be cited when heavy drinkers seek liver transplants, or when smokers need heart bypass operations. In each case, the intervention would be rendered less effective by the habit.

The NICE guidance, which is still in draft form, was developed by its citizens council, a group of people who offer advice on a wide range of social issues. But it was finalised by the NICE board.

Vivienne Nathanson, the head of science and ethics at the British Medical Association, said that the guidance reinforced what had always been good medical practice. “I am delighted that NICE has not proposed a blanket ban on some treatments for some groups of people,” Dr Nathanson said. “That would have been wholly unacceptable.

“It would also be wrong if this guidance were to be used to ration healthcare.

“The judgment should always be, ‘Does this person need treatment?’ and ‘Will this treatment be of benefit?’ Every case should be considerd on an individual basis.”

The NICE report said that it could be difficult to determine whether someone’s illness was self-inflicted or not. There was no way of knowing, for example, whether smokers who had a heart attack would have suffered one had they not smoked.

As a result, it said, NICE should avoid discriminating against patients with conditions that are, or may be, self- inflicted.

But it added: “A patient’s individual circumstances may only be taken into account when there will be an impact on the clinical and cost-effectiveness of the treatment.”

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