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Refusal of Surgery for Smokers – To Be or Not to Be

The controversy over refusal of surgery to known smokers is all set to be rekindled this week with two renowned experts debating the issue in this week’s BMJ//. The issue was initiated by the decision of a primary care trust last year to remove smokers from the waiting lists to contain burgeoning costs. Professor Mathew Peters who is from Concord Repatriation General Hospital in Australia feels that the decision is justified under specific situations. Smoking increases the chances for cardiac and pulmonary complications .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 certain number of procedures will therefore ensure better clinical benefits to individuals and the community.

However Professor Leonard Glantz from the Boston University of Public Health has strongly condemned the move terming it “discriminatory”.

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.

"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.


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