4/2/2023 0 Comments Definition of insurmountable![]() ![]() For the purposes of paragraph EX.1.(b) “insurmountable obstacles” means the very significant difficulties which would be faced by the applicant or their partner in continuing their family life together outside the UK and which could not be overcome or would entail very serious hardship for the applicant or their partner”. The definition of insurmountable obstacles is as follows: It is important to note that the suitability and relationship requirements remain intact and mandatory, even in cases which seek to rely on paragraph EX1(b). However, under Paragraph EX1(b) of Appendix FM (and as further explained in Paragraph EX2 of Appendix FM), there are situations where certain aspects of these otherwise mandatory requirements may be waived in light of the ‘insurmountable obstacles’ to family life which a refusal of the application would otherwise cause to the couple concerned. If any of these requirements are not met, the visa application will typically be refused. To apply for immigration status under Appendix FM, the following requirements must be satisfied: Let’s help people to be well, not just tell them they are sick.Appendix FM contains the Home Office’s published immigration rules for individuals seeking to acquire legal status in the UK as the dependent spouse, civil partner, fiancé(e), or unmarried partner of a British citizen, settled person or refugee. This definition does not decry the role of biomedicine, but rather redirects our attention to the purpose and proper function of biomedicine. Notice that I have not mentioned disease, only illness and disability - the things that matter to patients. ![]() Health care should aim for the state of least possible illness or disability, or of maximal functional adaptation to illness or disability. So I would offer this goal for health care. Or we can accept a more functional model - health as unimpaired flourishing, as ‘the strength to be’ - as in, free of obstacles, or to be able to surmount obstacles, to my dynamic life plan. The narrower biomedical model - health as the absence (or cure) of biomedical abnormalities. There are three main concepts of health on offer. Thus health can be seen as the ability to flourish without being unduly impeded by illness or disability or, if necessary, by overcoming illness or disability. If I am Olympic skier I can regain health - I can still flourish - by seeking the courage to rewrite my life script. Unless I am an Olympic skier I can be healthy even after the loss of a leg. Bonhoeffer was saying that health is the ability to pursue our life story without insurmountable obstruction from illness. ![]() But what matters to patients is whether they feel ill, or their function is impaired.Ĭould health be a more positive concept? Can we go beyond facts and admit values into our concept of health? Dietrich Bonhoeffer defined health as ‘the strength to be’. ‘Two legs good, one leg bad.’ Certainly I have no desire to lose any limbs, but if I did could I not be healthy afterwards? Yet it is the only definition that makes sense within a biomedical model, and we are seeing our profession driven increasingly down a razor-sharp but narrow biomedical path. But should we view any deviation from perfection as pathology requiring treatment?Ī biomedical approach to health is to define it by norms. Logically, as none of us is in this complete state of wellbeing, we are all in need of medical intervention to correct ‘abnormalities’. The WHO definition sees us as closed, knowable systems where imperfections should be fixed. It is a flagrantly modernistic statement, and, like a statue of Lenin, it appears now as the ironic icon of a bygone age. Its faith in an attainable Nirvana is touching, but not credible. But this utopian vision is an unattainable ideal, bearing no relation to the struggles of real people in an imperfect world. Their definition of health is ‘ not merely the absence of disease or infirmity but a state of complete physical, mental and social well-being’. ![]() The World Health Organization made a bold offer in 1948. Although we are prepared to spend dizzying sums on health care no one seems quite sure what health is. ![]()
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