Fat People, Smokers Denied Routine Surgery

[Content Note: Fat hatred; "headless fatty" image at story link.]

This is utterly heinous:

Smokers and the morbidly obese in Devon (UK) will be denied routine surgery unless they quit smoking or lose weight.

Patients with a BMI of 35 or above will have to shed 5% of their weight while smokers will have to quit eight weeks before surgery.

The NHS in Devon has a £14.5m deficit and says the cuts are needed to help it meet waiting list targets.

They need to save money, so someone has to not get surgery—and it might as well be people for whom no one will be inclined to fight.

Just to underline how completely arbitrary this horseshit is, someone with a much higher BMI (which itself is a garbage measurement) than 35 could lose 5% of their weight and still have a BMI over 35.

So what's the point?

The point, of course, is setting a threshold for access to healthcare that most people won't be able to meet.

The new restriction is "only" on routine surgery and not lifesaving surgery. (So they claim.) Among those routine surgeries are "hip and knee operations for the morbidly obese." If you're thinking, gee, it might be difficult even for people who can lose weight via diet and exercise to lose weight without full use of their hips and/or knees, welcome to the world of being a fat person who can't fucking win.

In a statement the Royal College of Surgeons said it was "concerned" by the move and warned the region was merely storing up "greater pressures" for the future.

It said: "The need for an operation should always be judged by a surgeon based on their clinical assessment of the patient and the risks and benefits of the surgery - not determined by arbitrary criteria.

"Losing weight, or giving up smoking is an important consideration for patients undergoing surgery in order to improve their outcomes, but for some patients these steps may not be possible.

"A blanket ban on scheduled operations for those who cannot follow these measures is unacceptable and too rigid a measure for ensuring patients receive the best care possible."

Well, at least the Royal College of Surgeons has some fucking sense. For some patients these steps may not be possible. Imagine that! It's almost like it's a terrible fucking idea to draw arbitrary exclusion lines instead of doing your job and taking the time to work with patients on an individual basis.

Granted, arbitrary exclusion lines are so much easier.

The thing about successful surgical (and other healthcare) outcomes is that patient compliance is the most important component. It doesn't matter if someone is a thin non-smoker; if they don't follow post-surgical recommendations, don't comply with recommended physical therapy, don't take their meds, etc., they're not going to have a successful outcome.

Certain types of mental illness or neurological disorders tend to be incompatible with rigorous patient compliance. The line is not drawn there, however, even though this is ostensibly about best outcomes, because it would be an outrage for healthcare providers to suggest that someone with mental illness doesn't deserve access to routine surgery because they might not make good decisions afterwards.

(This does, by the way, happen. Individually and quietly. There are profoundly disablist policies in healthcare services, including here in the US, especially around lifesaving surgeries like transplants, used to deny people care. It just tends not to be made public so brazenly.)

This is a public policy position, and so they make the choice based on stereotypes about fat people and addicts (but only addicts to cigarettes, who are "nuisances" and not addicts)—people who are largely assumed to not give a fuck about their own health and who are widely despised with impunity.

It's an outrage to draw this line anywhere. Individual patients need individual care and individual decisions.

Fat people are being scapegoated, targeted by people who don't want to make tough decisions. So instead they make lazy ones.

And, the truth is, many of the "routine" surgeries they want to deny meaningfully affect people's ability to move and thrive. This isn't a neutral decision. It will negatively affect fat people's and smokers' health. But we're not supposed to think about that. Or care about it, because, hey, they're definitely for sure obviously already unhealthy anyway.

This could shorten people's lives. But who cares.

Fat hatred kills.