Are smoke free hospitals unethical?

(Letter: Smoke free hospitals)
http://bmj.com/cgi/content/full/327/7406/104

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.

Contact:

Stephen Head, General Practice Principal, Newark,
Nottinghamshire, UK
Email: shead@doctors.org.uk BMJ -- Press Releases
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