38. Is everyone entitled to the same health care?

This session uses role-play to explore the difficult moral dilemma of how to use limited resources to care for everyone in a society. Should people who are old have the same level of care as someone who is young and contributing to society? Should a smoker have the same rights as someone who takes care of themselves? We all want to be healthy but how much responsibility should we have for our own health?

INTRODUCTION

Explain that in this country we are very fortunate to have the National Health Service (NHS). This means that we get health care when we need it – for free! In lots of countries, people have to pay every time they go to the doctor. We are going to look at one issue in particular in this session:

• Should people pay more for health care if they have become ill through their own fault?

Explain that in England the NHS is paid for through general taxation and national insurance contributions. This means that everyone can get health care even if they are poor or have no income, like many children, or even if they are to blame for their own health problems. It also means that expensive treatments are usually available that most people could not normally afford. Everyone who pays taxes thus contributes for the benefit of all.

Point out, though, that if the government wants to put more money into the NHS, particularly when there is a growing need, they either have to take more money in tax or they have to reduce spending on other parts of the economy, e.g., education, defence, farming, the environment, public services and so on.

In most other countries people pay for their own health insurance, but if you don’t pay, or can’t afford it, you won’t get treated, possibly except for hospital emergencies. Another point is that health insurance companies charge more to those believed to be at greater risk. Ask the children:

• which groups of people do you think are most likely to need more health care in their lives?
• what might happen if we changed to a system where people had to pay every time they needed to see a doctor?

Point that, regardless of how health care is funded, all countries face the challenge of a rising demand for services in response to ageing populations, new treatments and changing patterns of disease.

VOTE 1: Ask children to vote on this issue:

• Should people pay more for health care if they have become ill or are likely to become ill through their own fault?

ACTIVITY

Collect some views from the children and then ask them to think about a doctor who has limited time and money, but many possible patients. Give different children labels that say who they are, e.g., child, adult who works, mother, father, OAP etc. (This should be done sensitively according to children’s family situations.) Ask a different child to be the doctor. Assuming we don’t know the order in which people came to the surgery or what is wrong with them, who will the doctor see first? Why? What will the other characters say?

Act out the scene in the doctor’s waiting room where everyone has been waiting a long time to see the doctor. The doctor has been very busy already today and has only enough time to see two or three patients – half the number waiting! In this scenario, it is the doctor him or her self who decides who they will see next.

If the group is large, some children could have the roles but others could be the ‘audience’ who are invited to offer suggestions, ask questions or argue a point using a freeze-frame technique where the action is ‘paused’ in order to allow others to intervene.

Now repeat the scenario asking children to pull another card out of a hat with an added description such as smoker, keep-fit enthusiast, junk food addict, dangerous driver, as appropriate to the ages and sensibilities of the group. Ask another child to be the doctor. Who will he or she see first now? Why? What will the other characters say? Can the other characters give reasons why they should be seen rather than someone else?

VOTE 2: Ask children to consider the medical ethical principles of equality and fairness and to vote again on the same issue:

• Should some people pay more for health care if they have become ill through their own fault?

Does anyone say that NHS care is free at the point of need for everyone, regardless of who they are?

CONCLUSIONS

Collect the votes and see if the children have changed their opinion during the course of the session. Ask for their reflections on such questions as:

• If you have changed your mind can you tell us why?
• Do you agree that all life is special?
• Do some people have a greater ‘right’ to life than others?
• Do some people have a greater ‘right’ to medical treatment than others?

This could be related to stories and traditions in different faiths. For example, in the Bible, Jesus takes especial care of those in need, whoever they might be, even those hated or feared by the rest of society; or when Muslims go on their pilgrimage (the Hajj) they all wear the same, simple clothes so that they all see themselves as the same – as God would see them.