What kind of public healthcare should smokers get?

From the UK Daily Mail:
"There is increasing evidence that smokers have three times the number of complications as non-smokers. What we are proposing is that if someone who smokes is being referred for surgery, we would instead want them to be referred to a smoking cessation clinic and give them three months to stop smoking."

Dr Battersby added: "What we are doing is asking people to have a stab at giving up for three months and at the end we would review the situation. Some people will have stopped and will go on and have a referral for surgery. Others will not have stopped."

In those cases, decisions will be taken along the lines of clinical need.
I've always thought that public healthcare should have incentives built in to promote people keeping themselves healthy. Smoking is a pretty clear cut example of this. It doesn't much sense to spend a lot of public money treating people who are killing their bodies with cigarettes.

Posted by dustin on October 23, 2006 with category tags of

...except of course (and I say this as a person with enough cardio fitness to compete in bike races) such creeping triage-by-lifestyle is exactly the sort of coercive thing that will both drive people away from supporting a public health system and simultaneously lead to creepying nannyism.

There's already a great number of minor movements to tax or coerce dietary choices, and it would seem a natural extension of such medical regulations.

Now Dustin: would your lifestyle be proscribed because you drink too much alcohol for good health, or too little?
   comment by Ryan Cousineau on October 23, 2006

I think some good changes could make people support our public health system more.

If a person came into the hospital every week having drank some poisonous substance, a rational approach would give them some support for stopping such self-destructive behavior. That's what the UK approach I linked to is trying out with smoking.

Personally, I actually think that cigarettes (addictive and deadly) should be illegal. That would moot any point here. Since they are legal though, I don't think it's unreasonable to ask a smoker to stop killing himself before we spend our efforts to help their health.

Your alcohol question is clever. I don't drink a glass of wine every day... but some nights I'll have more then one drink. Either way, the behavior is a far cry from smoking, which has been determined to be a killer.
   comment by dustin (#1) on October 24, 2006

Wait, you support legal marijuana but illegal cigarettes?

   comment by Bryan on October 24, 2006

Science has informed us that cigarettes are addictive and deadly. They are only legal for historical reasons.

Similarly, marijuana is illegal for historical reasons. Scientific study of it has been stunted by its illegal status. If it was shown that smoking marijuana was as bad as smoking cigarettes I would support a law against smoking them both.

Also, if marijuana were legal, it would be much more available in safer forms of ingestion like cookies and other foodstuffs.
   comment by dustin (#1) on October 24, 2006

D (and everyone else, as I think this could become an even more interesting discussion), do you think an alchoholic or an obese person should be asked to killing himself before we spend our efforts to help their health? What about someone with an eating disorder or a cocaine additiction? I think the problem with waiting three months is that in some cases the person could be dead by then, or unable to cease the behavior within that time frame.

Either way, I agree about cigarettes as being addictive and deadly. Certainly the public healthcare system should support smoking cessation programs. If someone is helped medically and continues to smoke a pack a day, they are only going to have more medical problems. In the past, I never smoked more than six cigarettes a day, but my boss used to smoke upwards of 70 a day, and a pack a day seems standard for most smokers. The sheer volume of toxic chemicals present in a cigartette simply doesn't exist in marijauna.
   comment by Marcella on October 25, 2006

Okay, but where do you stop limiting behaviours? As the joke goes, nobody gets out of here alive.

Marcella: butt for butt, I'd bet there was virtually no difference in the volume of toxic chemicals in marijuana and tobacco cigarettes. To the extent that chronic chronic consumers don't die of lung cancer, I'd guess it has more to do with the improbability of a 2-pack-a-day THC habit.

More hypotheticals: motorcycle riding is about ten times as dangerous as cycling. Should repeat crashers be denied treatment after their third accident? Certain types of off-road mountain biking (namely freeriding) are notoriously hazardous. Should we mandate that such riders sell their MTBs before treatment? Perhaps we could offer them exchange credit on nice safe stationary bicycles. Hey, I know! Mandatory DNRs for DUIs!

Smoking is a tempting victim because none of us enjoy smoking, and because it is credibly the current most-expensive "leisure activity" for the medical industry.

But I would urge you to consider creating a philosophical structure that allows you to figure out why one thing is forbidden and one thing is compulsory before you just pick off the next item on the list. Because once you force people to choose between medical treatment and smoking, then you can move on to the next bugbear. Will it be drinking? Red meat? Insufficient vegetable consumption? White sugar? Sloth?
   comment by Ryan Cousineau on October 29, 2006

Don't treat the old and unhealthy, say doctors - Telegraph
   comment by dustin (#1) on January 28, 2008


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