NHS hospitals must become completely smoke free, says NICEBMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f7105 (Published 27 November 2013) Cite this as: BMJ 2013;347:f7105
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While almost all doctors will inevitably welcome the idea of a complete smoking ban on hospital sites as a part of a coordinated public health strategy we must be mindful of unintended consequences.
There are several situations where I would feel that my duty to provide compassionate care outweighed the need to ban all smoking around the hospital. These range from a patient approaching the end of their life who wants to have a cigarette to those with acute anxiety and distress who too often are sedated on an acute ward when a cigarette would have done the job. Other patients are deprived of their liberty by the mental health act or through the use of a best interests decision under the mental capacity act. Is it right to refuse to allow those patients a cigarette if it is the patient's wish to reduce their stress level? Indeed how can one use the "least restrictive option" if the patient simply wants a cigarette and the alternative is sedation and restraint? Those who have capacity may well self discharge or potentially may be sectioned when otherwise this would not be needed.
I remember clearly when I was revising for the MRCP that questions stating that something never should happen or always do are by rule of thumb false as there is always an exception to every rule. Physicians should be extremely careful to ensure that we always have access to the exception if that is what is required to help our patients in times of crisis.
Competing interests: No competing interests