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ADVANCE Perspective: Respiratory Views

Who Needs to Butt Out — Smokers or the Health Care Industry?

Published February 5, 2008 1:34 PM by Colleen Mullarkey
Across the world, smokers and non-smokers alike have responded in outrage to the increasing number of policies denying smokers some forms of health care. Most recognize the medical and economical considerations involved in these decisions, but even some non-smokers feel such policies cross the line when it comes to civil liberties. No official policies have cropped up in the U.S. yet, but they're gaining momentum in other parts of the world.

In the U.K., the British Health Service can deny operations for smokers unless they give up cigarettes at least four weeks prior to the procedure. The ruling applies to routine operations, such as hip replacements and heart surgery for conditions that are not immediately life-threatening. If smokers refuse to quit, they still have a chance at treatment but they'll have to wait longer.

A few highly-publicized cases have made their rounds on the blog circuit, narrating the tales of patients from Australia and the U.K. who have been refused elective surgeries unless they quit smoking. One example involves a National Health Service hospital in England that refused to operate on a 57-year-old man, who had broken his ankle in three places. They said his heavy smoking would hinder the healing process and increase the risk of complications, and refused to operate unless he quit. The man made several attempts to quit with no success and said he even cut down to just two cigarettes a day, but the hospital wanted all or nothing. Alternatively, doctors prescribed him morphine for pain management - a somewhat ironic response to the man's refusal to give up an addictive substance.     

While many hospitals and administrators feel this is a purely sensible, clinical decision to cut costs and improve patient outcomes, others feel it's an outrageous violation of personal freedom - some have even deemed it "torturous and cruel."

No one can deny the immense benefits of quitting smoking, but is it fair for the health care industry to make this decision for a smoking patient while so many other patients indulging in unhealthy practices slip under the radar?

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