Intended for healthcare professionals

Feature Head to head

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

Smoking is a disease

Smoking is a disease by many definitions. So is obesity, and alcoholism, and each is driven by behavioural factors sometimes referred to as choice.

The role of the physician whose proper client is his patient is to act in that individual person's best interests. Otherwise, the physician should confess the competing interest (like some notion of the public purse) to his patient, and if conflicted, refer the patient to an unbiased provider. If a person or his disease is distasteful to a physician, he should confess and refer, rather than construct arguments that rationalize, or worse impose the prejudice by policy in disfavouring one person for another. All persons should be considered equal in dignity and rights, and triage for access to limited resources should be according to need, not by social or any other lottery.

If it is the mission of a well-meaning physician to 'fight smoking' then he should address smoking, not the smokers, and surely not in the face of illness and a need for care. If it is the wish of society to save money by restricting healthcare, then the societal gain by taxation of tobacco consumption, and complicity in subsidising tobacco production must also be considered - as well as wasteful and harmful government practices which compete with healthcare for resources.

Striking at the root of the problem, which is the tobacco industry and the smoking behaviour is the appropriate response. Discrimination in medical management or healthcare policy against those suffering disease is not only disrespectful and harmful to the patient, but to the medical profession.

Competing interests:
I no longer smoke.

Competing interests: No competing interests

09 January 2007
D William Cameron
Professor of Medicine
Ottawa, Canada K1H 8L6
University of Ottawa at The Ottawa Hospital