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Should smokers be refused surgery?

BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39059.503495.68 (Published 04 January 2007) Cite this as: BMJ 2007;334:20

Should smokers be refused surgery?

MJ Peters believes that smokers who fail to quit smoking should not
be considered for elective surgery (1). His argument is based on his
belief that the costs are increased and outcomes are worse in smokers than
non-smokers.

This theme is not new and the readers of the BMJ may remember the
controversy caused by the article published in 1994(2). In that article M
J Underwood and J S Bailey stated that the smokers should not be offered
coronary artery surgery because in their opinion "subjecting patients to
the increased risk of surgery in the face of a remediable cause is not
justified.” In responding to their article I had argued that the NHS
professionals tend to ignore the fact that they are appointed to provide
service to the patients on the basis of their clinical needs irrespective
of their shortcomings and degree of culpability(3). I would like to
reiterate my argument that the surgeons are trained by the tax of both
smokers and non-smokers and, in return, the tax payers expect them to
provide prompt and efficient service when required. I am sure that no
surgeons would refuse to operate on a smoker if he or she was paying a
handsome fee as a private patient. I would also like to draw his attention
to the paragraph 7 of 'Good medical Practice' published by the GMC. It
states that 'The investigations or treatment you provide or arrange must
be based on the assessment you and the patient make of their needs and
priorities, and on your clinical judgement about the likely effectiveness
of the treatment options. You must not refuse or delay treatment because
you believe that a patient's actions have contributed to their condition.
You must treat your patients with respect whatever their life choices and
beliefs. You must not unfairly discriminate against them by allowing your
personal views* to affect adversely your professional relationship with
them or the treatment you provide or arrange. You should challenge
colleagues if their behaviour does not comply with this guidance.”

I believe that 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. Gentle persuasion and
counselling are the only decent ways of changing patient’s lifelong habit.

(1) Peters M J. Should smokers be refused surgery. BMJ 2007;334:1 (6
January)

(2) Underwood M J, Bailey JS, Shiu M, Higgs R, Garfield J. Should smokers
be offered coronary artery surgery? BMJ 1993;306:1047-50 (17 April)

(3) Khalid MI. Access to heart surgery for smokers. BMJ 1993;306:1408 (22
May)

Competing interests:
None declared

Competing interests: No competing interests

15 January 2007
Mohammad I Khalid
Locum Consultant Cardiologist
Fairfield General Hospital, Bury BL9 7TD