Tuesday, March 24, 2009

Smokers Not Allowed in Maternity Waiting Room of Royal Oldham Hospital

In what may be the first policy of its kind, the Royal Oldham Hospital has prohibited smokers from entering a public area of the hospital -- the maternity waiting room -- according to the Freedom to Choose web site. Dick Puddlecote's blog captured a picture of the sign outside the waiting room, which states: "In the interests of others, smokers are not allowed in this room."

The Rest of the Story

If you're straining to accept the credulity of the above, you did indeed read it correctly. The sign doesn't say: "smoking is not allowed in this room," it says "smokers are not allowed in this room."

To the best of my knowledge, this is the first policy ever in which smokers have been prohibited from entering a public place. All other smoke-free policies of which I'm aware have prohibited the act of smoking in various public places. I'm aware of no other policy that has banned smokers from entering a particular place.

Presumably, the "justification" for this policy is that smokers emit thirdhand smoke which could be harmful to patients in the waiting room.

Although there is no scientific evidence that thirdhand smoke -- such as the very minute levels of residual smoke constituents remaining in the breath of smokers or on their clothing -- poses any threat to health, let's go with this rationale for a minute and stipulate that the "claim" being implied by the Royal Oldham Hospital is accurate.

This raises two questions.

First, why would smokers be allowed in any areas of the hospital? After all, it is not just pregnant women who would be at risk from the toxins emitted by smokers. Even more at risk would be patients with respiratory disease. So you certainly wouldn't want to allow smokers on the respiratory floor. Nor would you want to allow smokers in the intensive care units. You certainly wouldn't want to allow smokers in the emergency room or emergency waiting room. In fact, if thirdhand smoke is really so much of a health risk that smokers cannot be allowed in the maternity waiting room, then they really shouldn't be allowed anywhere in the hospital.

Second, why would passive smokers be allowed in the maternity waiting room? If smoke particles that settle on the hair or clothing of a smoker pose a threat to women in the maternity waiting room, then wouldn't smoke that settles on the hair or clothing of a nonsmoker also pose a similar risk? So if a nonsmoker lives with a smoker, that individual's clothing is also going to be contaminated with residual smoke particles. Shouldn't these individuals also be prohibited from entering the waiting room? Shouldn't the sign say: "In the interests of others, active and passive smokers are not allowed in this room," or "In the interests of others, anyone who smokes or has been exposed to secondhand smoke is not allowed in this room."

This raises another interesting question. What if the pregnant woman who is waiting to deliver a baby is herself a smoker? Does this mean she cannot enter her own waiting room? Is there some secret, backdoor passageway into the delivery rooms that smokers must take? Are they asked to wait outside the hospital until their water breaks and then quickly and quietly ushered through hidden passages to get to the delivery room without going near anyone else?

To be consistent, why are only pregnant women afforded the protection of not having to be near smokers. Shouldn't we afford that same protection to infants after they are born? Perhaps the Oldham City Council should consider banning smokers from going within 20 feet of any infant. Of course, that would mean that smokers must not be allowed to enter the day care profession.

And why stop with infants. Children are also very susceptible to the effects of tobacco smoke. So Oldham should also prohibit smokers from being teachers, guidance counselors, or librarians, or from working in or entering a school.

You might ask: what would parents who are smokers do on teacher-parent night? This is not a problem. With advanced video technology, teachers could record a message about each student whose parent smokes and those parents could simply view the video without having to enter the school or classroom.

Astute readers might ask: what about smoking parents who want to pick up their infants from day care? Again, not a problem. Every smoking parent would be paired up with a nonsmoking parent. The nonsmoking parent would be in charge of going into the day care facility and picking up the infants of the smoking parents. The smoking parents would wait comfortably outside while their children are picked up by the nonsmokers. The risk of mixing up or losing a child would be minimal under this system.

Now the really insightful among you will ask the natural question: what about smokers who need to be admitted to the hospital? You can ban smokers from entering the hospital, but what if they are sick or injured and in need of medical attention.

Not a problem, I say. Simply set up a two-tiered system of medical care. You would have separate hospitals for smokers and nonsmokers. That way, the two would never cross paths.

Aha, you might say. What if a nonsmoker has a close family member who smokes, such as her husband? Does this mean that the husband cannot visit the wife while she is in the hospital? Well yes, but again, with advanced video technology, we could set up "virtual" visits with family members over the computer.

Another huge problem is what to do about infants or children whose parents smoke. Those infants and children are going to have clothing that is contaminated with smoke particles and they will therefore be a source of thirdhand smoke. What to do about those kids? Certainly, they cannot be allowed in day care centers or schools. The solution is to set up a two-tiered day care and education system, where there are separate day cares and schools for nonsmoking and passive smoking infants and children.

We already have peanut-free schools. I don't see why we cannot have "thirdhand smoke-free" schools. We already have smoke-free hospitals. I don't see why we cannot have thirdhand smoke-free hospitals.

Of course, there are a large percentage of nurses who smoke. This would not be a problem under my two-tiered system, because they could simply be assigned to work in the thirdhand smoke-laden hospitals. Similarly, teachers who smoke would be assigned to work in the thirdhand smoke-laden schools. The same is true for maintenance staff, administrative staff, and physicians themselves.

Under my policy, anti-smoking advocates should be happy, because it truly addresses the fact that, as reported in a recent Scientific American article: "Smokers themselves are also contaminated…smokers actually emit toxins [from clothing and hair]." Everybody is happy, and we can all peacefully co-exist.

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