Rationing health.

Should determined smokers be treated for heart complaints which are likely to recur as a result of smoking? This is one of the questions Joan Bakewell asks, prompted by the decision of Wythenshawe Hospital to refuse surgery to heart complaint patients who do not agree to give up smoking for a certain pre- operative period. At King's College Hospital, London, treatments to suicide casualties are not supplied indiscriminately. Is it up to the doctors to make such an assessment, even when the use of such a scarce resource as an organ for transplant is involved? So far as is known, this kind of discrimination is currently being applied to a very limited extent. But in the light of increasingly scarce resources throughout the NHS, is it not likely to become the rule rather than the exception?