HEALTH & SCIENCE

BRITISH MEDICAL JOURNAL DEBATES WHETHER SMOKERS SHOULD BE DENIED
TREATMENT

BRITISH MEDICAL JOURNAL - Last year a primary care trust announced it
would take smokers off waiting lists for surgery in an attempt to
contain costs. In this week's BMJ, two experts go head to head over
whether smokers should be refused surgery.

Denying operations is justified for specific conditions, argues
Professor Matthew Peters from the Concord Repatriation General Hospital
in Australia. Professor Peters says that smoking up to the time of any
surgery increases cardiac and pulmonary complications, impairs tissue
healing, and is associated with more infections.

These effects increase the costs of care and also mean less opportunity
to treat other patients, he writes. In healthcare systems with finite
resources, preferring non-smokers over smokers for a limited number of
procedures will therefore deliver greater clinical benefit to
individuals and the community.

He believes that, as long as everything is done to help patients to stop
smoking, it is both responsible and ethical to implement a policy that
those unwilling or unable to stop should have low priority for, or be
excluded from, certain elective procedures.

But Professor Leonard Glantz from Boston University School of Public
Health believes it is unacceptable discrimination. "It is astounding
that doctors would question whether they should treat smokers," he says.

"Doctors should certainly inform patients that they might reduce their
risks of post-surgical complications if they stop smoking before the
procedure. But should the price of not following the doctor's advice be
the denial of beneficial surgery?"

Cost arguments are made to support the discriminatory non-treatment of
smokers. But why focus our cost saving concerns on smokers? Patients are
not required to visit fitness clubs, lose 25 pounds, or take drugs to
lower blood pressure before surgery. And many non-smokers cost society
large sums of money in health care because of activities they choose to
take part in.

Discriminating against smokers has become an acceptable norm, he writes.
It is shameful for doctors to be willing to treat everybody but smokers
in a society that is supposed to be pluralistic and tolerant. Depriving
smokers of surgery that would clearly enhance their wellbeing is not
just wrong - it is mean, he concludes.

http://www.bmj.com/cgi/content/full/334/7583/20

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