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Where does “protecting the health service” end?

Across the western world, but very specifically in Ireland, politicians, the media, public health experts, and a large swathe of the public have accepted as an article of faith that the rights of one person are as naught compared to the needs of our health service.

This began, of course, with lockdown. Then, a broad swathe of society (including, for clarity, me) accepted that in the face of a new and potentially lethal virus, and the very real risk of a health service collapsing under the strain of tens of thousands of people requiring intensive care, it was acceptable for Governments to introduce temporary emergency measures aimed at reducing the spread of Covid 19, and “flattening the curve”. It is worth remembering that this, and only this, was the justification for lockdown.

18 months on, there is modified and new version of that same message which continues to underpin and justify every action taken by Government, up to and including the reauthorisation this week of emergency powers granted to it to manage the pandemic. Now, the justification is broadly similar, except that the threat of a health service being overwhelmed and thousands and thousands of people not being able to receive life saving treatments has largely passed.

But even if one disagrees about the level of the threat, the fact remains that most of us in society have gone along with the ride without ever thinking too much about where it leads, and what precedents we have set.

For example, it is a statement of fact that we have now embedded discrimination on the grounds of vaccination into our society in order, officially, to protect the health service. From day one, the justification for the covid passports, and all the attendant restrictions on the unvaccinated that go with them has been that unvaccinated people are more likely to end up in hospital, or cause others to end up in hospital (although the evidence for the latter point is largely imaginary, and non-existent).

So where does this principle end? For example, it is well known and proven beyond all doubt that smokers place a much greater strain on the health service than non-smokers. And that the obese place more of a strain on the health service than the lean and fit. And that alcoholics end up in hospital more than the teetotal. And on, and on, and on, it goes.

What we have embraced in Ireland is something entirely new in the history of western democracies: A legal requirement to take medical advice and look after your health. That’s what it is, and there is no other way to describe it. The doctors and politicians have decided what health decision you should make, and there is no choice in the matter. It is the greatest extension of state power over the individual in the history of this state – far beyond, for example, the alleged impositions imposed by the 8th amendment. In that case, at least, whether one agreed or disagreed, the law sought to protect unborn children. In this case, the law is explicitly designed to protect an institution – the health service.

The potential consequences of this are not hard to see.

It is politically difficult and challenging to increase the scope and capacity of a health service. In fact, given growing population numbers, and an ever aging population, and the unlikelihood of the state ever wanting to employ more doctors than it needs, the basic reality is that a state run health service will always be under pressure. And politicians will always worry about being blamed for hospital overcrowding.

But Covid has opened up a whole new world of possibilities. Politicians no longer have to accept the blame for the state of the health service, and can transfer it onto the public instead. And, it turns out, this is a message large numbers of the public are receptive to: You’re not being careful enough, you’re not being healthy enough, you’re not doing your part.

So what’s to stop this very same approach being deployed again, and again, into the future? As future winter flu seasons approach, or other factors cause a health service to be under strain? What guarantee is there that the response to health service overcrowding will not be to blame a section of the public for being “unhealthy”?

You may think, instinctively, like me, that such speculation is unlikely, and bordering on the conspiratorial. But ask yourself: How likely would you have considered it, a year ago, that you would need to show, in effect, a health pass to enter most venues? Is it really and truly beyond the pale to imagine in future having to show a certificate that you are not a smoker, to do the same? Or to encourage weight reduction, by demanding that people be weighed on the way into venues? We know, for example, how concerned those people in NPHET have been, for some time, about alcohol use. That concern drove the alcohol minimum pricing legislation. What’s to stop them requiring people to show a certificate showing that they have completed a course in responsible drinking?

The latter one is a deliberately absurdist example, but the problem is this: It’s very hard to find an argument against it that isn’t “but that’s absurd!” once you accept the principle that we do it for Covid 19.

Ireland is not famous, of course, for having philosophical worries about the policies it enacts, or giving much care to the precedents it sets. Voters probably don’t think about this kind of thing very much at all. The fact that they do not, of course, is one of the major downsides of democracy.

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