Access to surgery for smokers. Denying treatment is indefensible.

Abstract

Access to heart surgery for smokers Denying treatment is indefensible EDrrOR,-M J Underwood and J S Bailey believe that coronary bypass surgery should not be offered to smokers.' Medical professionals tend to ignore the fact that they are appointed in the NHS to provide service to patients on the basis of their clinical needs irrespective of their shortcomings and degree of culpability. After all, it is the money of taxpayers (smokers and non-smokers) that is used to train cardiac surgeons and to pay their wages. The taxpayers, in return, expect them to provide prompt and efficient service when required. I am sure that no cardiac surgeon would refuse to operate on a smoker if he or she was paying a handsome fee as a private patient. We should all feel privileged to be in a position to make decisions affecting the lives and livelihoods of our fellow beings and resist the temptation to abuse our authority. Those who believe that smokers should not be offered necessary investigations and treatment solely on the basis of their habit, in my opinion, have an indefensible case. Gentle persuasion and counselling are the only decent ways of changing a patient's lifelong habit.

Personal responsibility within health policy: unethical and ineffective

“…While many have warned about the risks of allowing judgements of blame to enter into healthcare settings,22 25 33 and most proponents of taking responsibility into account in healthcare avoid any discussion of blame or retribution, some have explicitly acknowledged the importance of culpability within this debate 17. Perhaps, different degrees of culpability are driving authors to focus on the considered cases and ignore the unconsidered cases.…”