Denying Treatment To Smokers

For many years, smoking has been one of the most popular topics in our health education. Many people are aware that smoking causes a great deal of diseases ranging form minor cough to deleterious lung cancer. However, many smokers tend to continue their hazardous habit despite advices from health care providers and campaigns from many organisations, hospitals or even local pharmacies. Hence, the question is ‘Should patients who refuse to stop smoking be prevented from getting treatment from National Health Service(NHS) for smoking related diseases?’ It is a common fact that individuals will take responsibility of their health implications if they have to bear the cost of their own health, but when government body such as the NHS bears the health cost, moral obligations of doctors and NHS are brought to question if they deny these individuals of treatment due to their behaviour. In this discussion we will consider the general outlook of smoking, smokers involved and the pros and cons of denying treatment.

Smoking generally has been a norm in our modern culture and is highly popular among men. More interestingly, the practice has begun as early as 5000 BC to 3000 BC in south America when tobacco was first planted [1]. Tobacco is used in medicinal purposes such as analgesic and antiseptic, ritual ceremonies whereby tobacco was offered to the Gods, insecticides in agriculture, drunk as tea, etc [1]. Tobacco was thought to have medicinal properties that can help cure and prevent cancer in the sixteen century. Ironically no one knew of the hazardous consequences of smoking until the early twentieth century. The first evidence of the effects of smoking related disease occurred in 1950 particularly link to lung cancer. Since then more researches and investigations have been carried out on the effects of smoking towards health. By the late twentieth century, much evidence have proven that smoking cigarettes is a major cause of heart disease, COPD (Chronic Obstructive Pulmonary Disease), stroke, numerous types of cancer such as lungs, cervix, oral cavity, penis etc. In addition smoking also increase the impotence rate among men and abortion among pregnant mothers. Since then many health care providers as well as government authorities have begun to take serious measures such as launching anti smoking campaigns, increase of tobacco taxation and educating the public on the dangerous effects of smoking.

Before we explore further, we must first ask ourselves another relevant question which is ‘Why do smokers continue to smoke despite knowing the bad consequences that will befall their health?’ According to a survey, 90 per cent of regular smokers have tried to quit on at least one occasion but only 36 per cent had succeeded in maintaining abstinence for a whole year, while relapse rates after a given period of time are almost the same for nicotine as for heroin [2]. In biological terms, it seems that smoking causes an addition for nicotine in the human brain which is rather difficult to overcome by smokers. Furthermore, in campaigns; smoking related disease are usually related to the dangerous lung cancer and common COPD (Chronic Obstructive Pulmonary Disease) but the risk of circulatory diseases such as Buerger’s Disease [3] and coronary artery disease are seldom emphasised. For example coronary artery disease patient needs to undergo coronary artery bypass graft surgery [4] where surgeons need to carry out a major operation. In these cases, surgeons usually consider the minimum side effects and maximum benefit of the surgery for a patient. This is rather a tricky part for NHS as major operation usually contributes to a huge amount of medical cost. Apparently NHS spends £5.2 billion a year to treat smoking related diseases [5]. In addition, circulatory disease also contributes to the highest patient admission in NHS compare to other smoking related diseases with a number of 686,942 patients in year 2007/08 [6]. It is also equivalent to 47.6% of the total admission which is cause by smoking. Furthermore the complications of this surgery are higher among smokers who continue to smoke after surgery than for non smokers.

Coming back to the major question, if NHS denies treatment of this kind to smokers who refuse to stop smoking, more opportunities are given to a non smoker with the similar disease to receive treatment as there are more surgeons and hospital beds available to treat them. Moreover the surgery performed is more efficient and effective. In addition, their survival chances are also higher compare to those who continue smoking after surgery [7]. Apparently, smoking at any time of the surgery leads to more infections and impairs tissue healing. Studies have shown that overall complications in knee or hip arthroplasty for those who have quit smoking are 10% compared to 44% in those who continue to smoke [8]. On the other hand, money could be saved and be contributed to other areas such as to the smoking cessation service such as ASH (Action of Smoking and Health). Currently the NHS Stop Smoking Services is spending about £57.5million in year 2008/09 in pharmacotherapies to help smokers to quit smoking. Comparatively, 337054 smokers managed to quit smoking by the year 2008/09 through NHS Smoking Cessation Services [9]. Besides, non smokers who are usually the victims in passive smoking may also benefit by getting a cleaner and smoke free environment.

However, this move is ethically wrong according to the NHS principles where principle number one states that “The NHS will provide a universal and comprehensive service with equal access for all, free at the point of use, based on clinical need, not ability to pay” and principle number five states that “We will treat every patient with dignity and respect” [10]. To summarise both principles, it states that NHS should provide equal treatment to any patient based on their clinical needs and also respect their health care rights regardless of their background to seek medical treatment. Denying treatment from smokers also means that taking health care rights away from them and it is a rather inhuman act to do.

Besides, it is also ethically wrong for doctors to deny patient’s right of treatment as it contradicts with the doctor-patient relationship and it is against the Hippocrates law which states that ‘The health of my patient will be my first consideration [11]. Doctors working under NHS must abide with the oath and carry out their duty to treat their sick patient. Therefore doctors who work for the NHS should not be influence by the situation of NHS to offer treatment to their patients who smokes. In addition, let us view on patients’ right for treatment; according to the Declaration of Lisbon, “The patient has the right to accept or refuse treatment after receiving adequate information” [12]. In other words it also means that it is the patients’ right to decide whether he should receive the treatment and not the authorities such as NHS. In a nutshell, the patient also has the right to be cared for by a physician who is free to make clinical and ethical judgement without any outside interference.

Based on the pros and cons, I would like to conclude that it is unfair for NHS to deny treating patients who smoke. This is based on several reasons; firstly, NHS should not discriminate against patients who smoke owing that they knew the health implications of their hazardous habit. Many may argue that smoking related disease is a self inflicted but in most cases the situation is far more complicated than it seems from the surface. For example, smokers may smoke due to several factors such as peer pressure, family problems and cigarette advertisement in the early twentieth century. In addition to that, the addiction to nicotine is similar to heroin. Many have tried to give up smoking but chances of succeeding are slim as they might be shy to consult their health care provider and it is challenging to go against the addiction. Furthermore NHS smoking cessation services was recently set up in the early twenty first century. As humans, we err as well and we should be given an opportunity to correct them. Therefore I feel that smokers should be given more time to quit smoking and more anti smoking campaigns should be launched to create more awareness instead of taking a drastic move as to deny treatment to patients who smoke. On the other hand, other alternative ways such as raising tobacco tax is an effective measure to encourage smokers to quit and increases the number of people who never smoked before. Very recently, the UK government is considering to increase the tobacco taxation by 5% and a survey on its effects was carried out by ASH [13]. One of the major advantages in this policy is it help reduce the number of smokers and increase NHS cost saving. In a nutshell, I think it would be better to continue treating patient who smokes as well as to increase tobacco taxation and having more smoking cessation campaigns.