According to an article published Wednesday by Medical News Today, a major U.S. anti-smoking group appears to support the denial of surgery to current smokers; only ex-smokers would be eligible for surgery under the policy supported by the group: Action on Smoking and Health (ASH). According to a policy being considered by the Leicester City Primary Care Trust, smokers will be denied surgery unless they quit smoking for at least four weeks and their abstinence is confirmed via a cotinine blood test.
According to the article: "Medical research shows that smokers take far longer, on the average, to recover from operations, and are far more likely to suffer serious medical complications. This not only greatly increases the cost of providing surgery to smokers, but also ties up beds and hospital facilities urgently needed by other patients. ... Professor John Banzhaf, Executive Director of ASH, notes that some physicians in the US have refused to perform operations on smokers, and that potential recipients may be denied life-saving organ transplants if they smoke, just like patients who abuse alcohol or use recreational drugs. 'Smoking not only causes many very serious and very expensive diseases, but also exacerbates many existing medical problems and complicates recovery from virtually all operations. Thus a smoker who sufferers a broken leg while skiing -- a condition obviously not caused by his smoking -- is much more likely to suffer respiratory complications and/or infections as a result of the surgery, and to take far longer to heal,' says Banzhaf.'"
"'Generally, since most health insurance companies charge smokers the same rates and provide them with the same benefits, these added costs and delays in providing services to others are absorbed by the great majority of patients who are nonsmokers. This is manifestly unfair. One remedy is to charge smokers more for their health insurance, a policy the federal government recently recommended and approved. Another is to deny smokers certain services, especially if their smoking is likely to impair their outcome.'"
The Rest of the Story
It's hard to believe that it has come to this. A prominent anti-smoking group is actually supporting the denial of appropriate and necessary medical care to smokers solely on the basis of a somewhat higher rate of complications. It is critical to understand that the patients' smoking is but one of a myriad of factors that influences post-operative recovery time and complication rates. The majority of smokers do not necessarily suffer complications and the increased recovery time is a statistical phenomenon that may not apply to an individual patient. Thus, categorically denying surgery to smokers represents blatant discrimination, and from a medical perspective, it is unethical.
I'll tell you another thing that increases post-operative recovery time and complications, and perhaps even more than smoking: obesity. Like smoking, patients who are overweight cost the health care system more because they "are far more likely to suffer serious medical complications. This not only greatly increases the cost of providing surgery to overweight people, but also ties up beds and hospital facilities urgently needed by other patients." Wound healing is much prolonged in people who are obese; respiratory complications are much more likely; overall recovery time is prolonged.
The same reasoning by which ASH is supporting the denial of surgery to smokers applies just as well to denying surgery to fat people until they lose weight. Why not deny surgery to fat people until they undergo at least four weeks of a rigorous weight loss program and their successful weight loss is confirmed by stepping on a scale?
If you substitute obesity for smoking, then ASH's statement reads: "Generally, since most health insurance companies charge fat people the same rates and provide them with the same benefits, these added costs and delays in providing services to others are absorbed by the great majority of patients who are not obese. This is manifestly unfair. One remedy is to ... deny fat people certain services, especially if their obesity is likely to impair their outcome."
My colleague at the Boston University School of Public Health - Professor Leonard Glantz - wrote in a January BMJ column: "The suggestion that we should deprive smokers of surgery indicates that the medical and public health communities have created an underclass of people against whom discrimination is not only tolerated but encouraged. When the World Health Organization announced that it would no longer employ anyone who smokes, public health and medical communities did not respond to this act of blatant bigotry. Similarly, 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."
I have already discussed a number of reasons why I think the idea of refusing medical treatment to smokers is inappropriate, unfair, discriminatory, and in conflict with the basic principles of medical practice. The rest of the story is that for the first time of which I am aware, a prominent anti-smoking group is actually publicly supporting such policies.
What a far cry from why I became involved in tobacco control in the first place. I decided to devote my career to tobacco control because I saw the suffering of many of my patients who were smokers and wanted to act out of compassion for these smokers. Today, the anti-smoking movement seems more motivated by a desire to overtly discriminate against and punish smokers. Instead of compassion, we seem to be motivated now primarily by hate, intolerance, or as Professor Glantz suggests - just plain meanness.
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