The time is ripe for a public debate on the rights and responsibilities of people who turn to the State for medical care, Democratic Alliance (DA) leader Helen Zille said on Friday.

"There is a growing assumption that people have the right to behave as they like, and the state has the responsibility to pay for the consequences," she said in her weekly newsletter, published on the DA's SA Today website.

About 80% of the public health budget was spent on the consequences of personal "life-style choices", ranging from unprotected sex, to alcohol and drug abuse, and the resulting trauma and violence.

Far too little was spent on people who had no choice in their medical conditions.

"When individuals make personal choices that have profound public consequences, it is a legitimate subject for public debate, especially when others are deprived as a result," Zille said.

The DA believed in human rights, but also in human responsibilities.

"Consider two extreme examples. First, a healthy young man, fully aware of the dangers, nevertheless has unprotected sex with multiple partners. He gets Aids and asks that the State should give him antiretroviral drugs free of charge. Should the State provide?

"Second, a baby is born partly deaf. Her parents ask that the State provide her with a hearing aid because they cannot afford it. Should the state provide?

"And what about a cochlear implant in the case of profound deafness? What about the requirements of children with a range of other disabilities?"

Zille said the past decade had seen important advances in upholding the rights of people with HIV.

"There must now be an equal emphasis on responsibility. The more we spend on treating preventable illnesses, the less there is for the unpreventable conditions that confront many of our citizens with severe challenges throughout their lives."

The Deaf Federation of South Africa had given appalling figures on the treatment of deaf children in South Africa.

"Only 12 of our 47 schools for the hearing impaired offer matric. Only 14% of the teachers are fluent in sign language. Thousands of deaf children have no access to education at all. The overwhelming majority of deaf children never reach matric, and only a handful reach university."

While the statistics were uncertain, about one million people communicated by sign language, out of an estimated four-million deaf or partly-deaf South Africans.

"There is a deep moral question here. We believe it is morally right that the state should provide for those that cannot provide for themselves," said Zille.

"This applies particularly to medical care. We also realise that in a developing country, resources are limited. We have very complex choices to make.

"The disabled have been far less vocal than other lobby groups. Being quiet, they are often quietly ignored. It behoves the rest of us to listen to them much more carefully," she said.