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Comment by Rule35 | Hacker News Reader

> If you donate to charities that help pay for people's HIV treatment, then no-one is being forced to pay

If I feel you brought something on yourself why would I help you and not an innocent victim? And how would charity help resolve the issue of you dumping the cost on others, it would just be me instead of all of us, but still subsidizing.

> It would clearly be a moral obscenity to systematically allow people to die of treatable diseases because they can't afford treatment.

No, only if that money couldn't do greater good elsewhere.

> And if it's a question of 'blame' or 'risky behavior', then we should be refusing treatment to anyone who's ever eaten a donut.

In some proportion to the number of donuts, yes. Of course. Or at least they should go to the back of the line after we've helped people who didn't self-inflict.

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I’m trying to look at this form the perspective of a religious conservative (presumably Christian, though I don’t know). “Only help others if you think they deserve it” is rather obviously not a precept that’s the basis of Christian charity. That is in fact why the OP says (quite despicably, in my view) that there is a conflict between justice and mercy in this case.

> how would charity help resolve the issue of you dumping the cost on others

OP objected to others being forced to pay. Charity is voluntary.

> Or at least they should go to the back of the line

What would this even mean in the case of the US. About 35% of adults are obese, and in almost all instances that’s due to their behavioral choices. Do we send a third of the population “to the back of the line”, or refuse to pay for their medical treatment?

I made my original post as an invitation to discuss my current views (which I admitted weren't settled). I was hoping to find any faults in my views' logic so I could replace them with something more logically consistent and, hopefully, loving.

The fact that you call my initial exposition "despicable" reminds me that HN isn't a good forum for this kind of discussion.

I regret posting a comment that elicited this kind of discussion.

Do you know of any first world countries where people are denied treatment for HIV depending on some assessment of whether or not it’s their fault that they’ve contracted it? E.g. we’ll pay for treatment if you get it from a blood transfusion but not if you get it sexually.

The proposal that you’re hinting at is very far outside the mainstream. I don’t think you’re likely to find any forum (that you’d want to be a part of) where it doesn’t elicit a strong negative reaction.

HN is probably one of few places that tolerates this kind of extremism enough to at least engage with your argument (such as it is) rather than just telling you to get stuffed.

> “Only help others if you think they deserve it” is rather obviously not a precept that’s the basis of Christian charity.

No, only help people if they didn't bring it on themselves and would probably be able to receive the help. There's no sense wasting a bunch of help on a junkie who won't use it, but once he's off the smack and willing to receive help then maybe. But only if a needy mother's kids don't need it more.

> Charity is voluntary.

Right, but you present it as an obligation. These people aren't being funded so you could just do it yourselves.

> About 35% of adults are obese, and in almost all instances that’s due to their behavioral choices. Do we send a third of the population “to the back of the line”, or refuse to pay for their medical treatment?

Oh boy, you're gonna hate this. Yes. And we already do. Try asking for an organ while you're a smoker. They give that sucker to someone who can use it and will take care of it.

What misguided sense of honor could force you to dispense treatment in the order people arrived in versus their need/ability to receive?

>No, only help people if they didn't bring it on themselves and would probably be able to receive the help.

You're suggesting that this is what Christianity has to say on the subject of charity?

>Right, but you present [charity] as an obligation.

No, I didn't. I pointed out that voluntary charitable contributions would be a good way to resolve the tension that the OP feels between 'justice' and 'mercy'.

>Oh boy, you're gonna hate this. Yes. And we already do.

In the case of organs there's an inherently limited supply, since people have to donate voluntarily and all sorts of other conditions have to be met. It's not as if we're throwing away livers rather than give them to alcoholics.

I'm sure you must be aware that we do treat all kinds of obesity-related conditions – and at great expense. In the case of HIV treatment, it's largely just a question of paying for drugs which can easily be manufactured in the required quantity.

But I guess at this point I'm wondering what your actual position is. Are you in favor of conditionally refusing treatment to HIV patients depending on the manner in which they contracted the virus? If so, why not just come out and say it? And if not, what exactly are you getting at?

> In the case of organs there's an inherently limited supply, since people have to donate voluntarily and all sorts of other conditions have to be met.

Yes, and charity spending on one person necessarily takes away from spending on another too. To support someone whose choice of behavior impacted them means you can't support someone who was injured entirely through 'acts of god'.

> It's not as if we're throwing away livers rather than give them to alcoholics.

No, but but they do go to the back of the line. Especially if they still drink.

> I'm sure you must be aware that we do treat all kinds of obesity-related conditions – and at great expense.

Sure. But thankfully we prioritize them to below children with heart defects, and non-obese adults with the same conditions.

> Are you in favor of conditionally refusing treatment to HIV patients depending on the manner in which they contracted the virus?

No more than I am for prioritizing treatment downward for everyone whose injuries were self-inflicted. That's only fair for the people whose were not.

I don't think you've really answered the last question. At the moment, in the US, how you contracted HIV makes no difference to your access to treatment. Do you think this should change or not?

As to the rest, you're obviously aware that in general, obese adults are not deprioritized for treatment as compared to non-obese adults.

> I don't think you've really answered the last question

That's pretty much a textbook example of sealioning. Why are you so anxious?

> HIV

Are they asking for charity? If not then their circumstances shouldn't be relevant, just their ability to pay.

> you're obviously aware that in general, obese adults are not deprioritized for treatment as compared to non-obese adults.

They are. If you're up for a contested treatment (a rare organ, a diagnostic machine that's always in use) you're given a score that represents your health and ability to benefit. Obesity isn't a total black mark but it absolutely is considered. However, we don't consider why you're fat, fat is just a health risk and we recognize that and don't waste effort where it won't be rewarded.

It seems you agree, then, that there is no ethical dilemma in insurers paying for HIV treatment regardless of whether the patient acted irresponsibly. But it would be easier to understand your answer if you’d just say whether or not you think that access to HIV treatment in the US should be more restrictive than it is at present.

We already covered the special case of contested treatments. It’s obviously irrelevant here as we are just talking about access to drugs for HIV patients, not access to an inherently limited resource. Either you pay for Truvda or you don’t. There’s no queue.

Similarly, if you are obese, no generally available treatment that could be of medical benefit to you will be denied merely because it’s expensive and you’re obese.

> Similarly, if you are obese, no generally available treatment that could be of medical benefit to you will be denied merely because it’s expensive and you’re obese.

Nope. There's a limit to everyone's insurance, beyond which they will not pay for more treatment. You won't get told that you're too fat but your treatments will cost more and consequently you'll get less of them. Your insurance contract is for a sum of money, not a specific set of life-saving actions.

But generally that limit is much higher than what you've paid so your expensive treatments take money from the pool.

> there is no ethical dilemma in insurers paying for HIV treatment regardless of whether the patient acted irresponsibly.

As long as their fees cover the payments. But if they're costing more than they're paying as a class, meaning that all other users are compensating them, then yes - dilemma.

> It’s obviously irrelevant here as we are just talking about access to drugs for HIV patients, not access to an inherently limited resource. Either you pay for Truvda or you don’t. There’s no queue.

Paying out of your own pocket, 100% fine regardless.

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