EDITOR, - J T Powell and R M Greenhalgh continue the debate on whether the medical profession has a right to decide whether smokers should be entitled to bypass operations.1 They point out that smoking is related to heart disease and to less successful bypass surgery and are therefore justified in asking “on the basis of this evidence what advice should we give?” But they are not content to advise smokers: they feel justified in advocating coercion. They state that continuing smokers “with inconvenient arterial disease which is not life or limb threatening but in whom surgery could improve the quality of life,” should be denied surgery because “the operative risk and chance of bypass failure remain too high to justify surgery,” although “if the disease progresses no smoker should be denied urgent surgery to prevent amputation, stroke, or death.”

Findings of significant differences between …