Can we decide who should and who shouldn’t receive a costly treatment based on their life choices?
I recently launched myself headlong into a debate about whether the PRep drug should be rolled out. A debate centred around NHS Englands decision to turn its back on the obligation to provide PRep to people who feel they may be at risk of contracting HIV. The murky water that lashed against the shores of sanity seemed to be sullied with discussions of morality and justification. The argument was predominantly broken into two categories; those that felt condoms were enough of a barrier and by choosing not to use them the risk is a burden they must shoulder. The others questioned whether it was right to deny those most at risk a safety net and whether it was right to hold back treatment of HIV because of perceived promiscuity.
I foolishly entered the debate feeling as though anyone in the ‘for’ camp had pitched their tent high on the moral slope, safe from the rising tide of archaic judgment and persecutory rip tides. Peering down into the gloom of archetypal people throwing moral missiles at unyielding, light footed knights of justice and equality. My only argument at first being that the high court ruling was not an outright support of gay men, but in fact support for anyone who was at risk from contracting HIV.
The next stage of my ‘gallantry’ is where it began to unravel. I charged head long at a gentlemen for his outright objection to supplying a costly drug when “Avastil” is underfunded and unavailable on the NHS. My arrogance was to believe that the ol’ boy had deep rooted anti-homosexual, anti-promiscuity theories that were ingrained from a life of attending church every Sunday like a righteous soldier of faith. I have long held the belief that people can harbour atrocious prejudices if they tell the good lord that they repent for kicking the dog on Friday because ‘er’ in doors’ hadn’t gotten dinner ready on time.
I had judged all of this from one simple sentence questioning whether the NHS could afford an expensive drug and what would be sacrificed.
I questioned the gentleman on his conviction that it was right to refuse the drug based on a theory that they were to blame for their ‘hedonistic’ lifestyle. To try and justify the cost over the saving of a life to me seemed as though a finite numeric value was being placed on the heads of red blooded people capable of good and bad in equal measure. I replied with many well meaning and forceful counters to these arguments, cutting through the injustice with a sword of salvation for the under represented.
This went on for a bit with many others chiming in to offer different tangents as to why this person could have so much courage of conviction when talking about who is more deserving. It was at this point I felt I was being a shit, this guy was so strongly holding onto his opinion that I had to justify why I had the right to tell him was wrong. I began to ‘pull my punches’ and re-write my counters several times, omitting personal jibes and character assassinations, replacing them instead with alternative perspectives and justifications outside of moral notions. Others rightly questioned whether all people that sacrifice their bodies to aggressive illnesses should be excluded also, the answer of course was not needed as it’s already happening and will do so for the foreseeable future.
I couldn’t wrap my liberal sensibilities around the idea that one person is more deserving than another simply because they have lived a life of “thou shalt not”. Could it really be so simple? Could we really ‘play god’ because someone has been good in a relative sense? It just didn’t make sense, a good person inevitably has bad traits so how can mere mortals decide who has the right to medicine based on moral judgments? “Let he who is without sin cast the first stone” as it goes. He cast his stone I threw my intentionally noble, but actually inconsiderate boulder back.
I suddenly realised that what he was talking about was an emotional thought process. To know the name of a drug and its effects is one thing, but to be able to use that name so abruptly and flippantly can only come from experience. To ask the question of whether its right to deny one party for the appeasement of the other could come from bitter experience not deep seated prejudices as I had arrogantly assumed. I swiftly attempted to make amends by raising my thoughts on his experiences without brazenly casting aspersions, I had after all cast more than my fair share already. A small ping and a red square appeared, a simple like, nothing pretentious just a like. My apology had been received, whether it had been accepted I don’t know nor do I wish too, for as long as I don’t know I can’t absolve myself from the judgment I had cast on a person I didn’t know. I was instantly humbled and there I wish to stay for I am human, fallible, flawed and ultimately in-perfect just like everybody else.
I did ask one thing to the gentlemen, a favour I didn’t deserve but I had to deliver in the hope of easing the trouble for all concerned. How it was received again I don’t know. I asked him not to be angry with the humanly flawed people for whom the debate was aimed at, not to be so heavily focused on who is more deserving of relief, but to be more focused on who is eating more than their fair share of the preverbal pie, for they are the real hedonists.
Can we decide who gets respite based on their life choices? That was my question, futile, simplistic and greyer than a British summer. Ultimately a rhetoric question, ‘we’ don’t get to decide.
The decision will not be made under a veneer of moral debate, nor will it be made on whether the ends can justify the means. It will be made based on a series of numbers, to dull for easily bored minds it will be plotted into block coloured bars so as to make the numbers more palatable, the higher the number on the y axis the more likely it will be rolled out. While we naively debate lifestyle over injustice they will debate net versus gross, we will share experienced stories based on first person perspective, they will share a golf cart on Thursday at four, we will pontificate whilst they propagate. We spend more time fighting each other in a Facebook Thunder Dome, desperately trying to re-take control of our destiny than we do holding our erroneous emancipators to account.
When did the placement of a decimal point hold the key to salvations we all deserve? Money makes money, it doesn’t make the holder judge, jury and executioner. We are not inanimate secondary colours filling cascading rectangles on a bar graph, we are people, committed to making mistakes and learning from them, muddling our way through life trying to balance what is right and what is rewarding, sadly they don’t always symbiotically travel.