Letters Smoke-free hospitals

Exempting patients from a smoke-free hospital policy on compassionate grounds

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g389 (Published 21 January 2014) Cite this as: BMJ 2014;348:g389
  1. Patricia Fitzpatrick, senior lecturer12,
  2. Irene Gilroy, health promotion officer1,
  3. Kirsten Doherty, acting health promotion manager1,
  4. Greg Conlon, health promotion officer1,
  5. Leslie Daly, professor of epidemiology and biomedical statistics12,
  6. Cecily Kelleher, professor of public health medicine and epidemiology, and head of department12
  1. 1Department of Preventive Medicine and Health Promotion, St Vincent’s University Hospital, Dublin, Republic of Ireland
  2. 2School of Public Health, Physiotherapy, and Population Science, University College Dublin, Dublin 4, Republic of Ireland
  1. patricia.fitzpatrick{at}ucd.ie

The situations that Mearns describes were discussed at the beginning of the planning process for implementing a tobacco-free campus policy in St Vincent’s University Hospital, Dublin.1 2 It was recognised that in some circumstances special arrangements would be needed to allow patients to smoke on the hospital site. To deal with such situations a strict exemption procedure overseen by consultants was developed. This procedure enables patients to smoke on campus in a controlled outside smoking area if a consultant thinks that their circumstances warrant an exemption from the tobacco-free policy. Exemptions are assessed on a case by case basis.2

Free nicotine replacement therapy, as well as the support of trained smoking cessation advisers, are available and offered to patients who smoke to manage nicotine withdrawal symptoms during their stay in hospital.

A set of difficult case scenarios or vignettes was developed to support staff in dealing with patients who smoke. These were based on real life cases seen by the hospital’s smoking advice service team and on problems raised during the consultation phase of the project. Training on how to deal with these scenarios, which related to patients and visitors, was made available to staff during implementation of the policy.

Furthermore, a continuing comprehensive communication strategy ensures that most patients are aware of the tobacco-free policy before admission.

Compromising compassionate care need not be an “unintended consequence” of a complete tobacco ban on hospital sites if there is a process to support staff in dealing with patients in the situations described by Mearns.


Cite this as: BMJ 2014;348:g389


  • Competing interests: None declared.


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