It has been reported that obese people are to be denied some surgical procedures in an attempt to cut costs in the NHS. Three Suffolk primary care trusts have decided that patients clinically determined to be obese will not get operations like hip and knee replacements. The reason given is that the risk of complications after treatment for obese patients are higher than other groups, but it is also said that financial limits are forcing hospitals to make difficult decisions. There are a number of responses, the ethical thinker might make to this. On the one hand it might seem to go against the idea that everyone should receive treatment on the basis of equality. We might say that, in our welfare medical system, everyone should receive treatment free at the point of need. But should we treat people the same? Should people who have chosen activities which harm then be treated at great expense to the greater number of people? What about criminals? All treatment must be paid for by someone, and with the NHS it is the tax payer. Hospitals have limited funds because the government takes a limited amount of money through tax. Medical treatments cost more and more because as every new treatment appears, more money is needed to pay for it. How should we decide who gets treatment, and what treatments are to be given? What sort of ethical thinker might we want to run our hospitals? Kant might find it very difficult to ever say no to a treatment. If we are going to treat one person this way, we should treat all who need it this way. There might be a tendency to universalize the decision – costs could run out of control. Joseph Fletcher might want to treat each case on its individual merits but is that really practical in the busy business of health care and would people accept it? There is already considerable public upset about the idea that in some parts of the country, some treatments are available but that they are not in others. So perhaps we do need utilitarians to run our hospitals, to make calculations in the interests of the greater number even if some minority groups loose out. Consider the other philosophers you have studied. How would they manage a hospital with the limited budget? How would they decided between patients and would they have objections to certain treatments, or to treating certain patients?