Are smoke free hospitals unethical?

July 10, 2003

A recent editorial attacked a decision by the Royal Victoria Hospital in Belfast to build seven smoking rooms for patients and staff. In response, a letter in this week's BMJ argues that smoke free hospitals are unethical.

To bar smoking for patients with smoking related diseases seems reasonable, but to coerce smokers who happen to be in hospital with an unrelated condition into accepting smoke free behaviour as a condition of their care may be questionable, writes Stephen Head, a general practitioner from Nottinghamshire.

When patients have no prospect of benefit from smoking cessation, and enforced abstention aggravates their existing distress, they are being managed unethically, he says. Their best interests as a patient (which should be the medical profession's prime concern) are being subjugated to a broader policy that does them harm.

He describes the case of terminally ill patient, whose last days in hospital were made worse for nicotine withdrawal. Another declined admission because he would have to give up "his one remaining pleasure."

Such cases should not blunt the public health message. But making their last days more distressing than they would otherwise have been reflects an uncritical policy enforcement that adds a cruel and condescending twist to how doctors and health managers, as much as the international tobacco industry, are able to create smoking related suffering, he concludes.


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