Smoker refused treatment.

[ch85us2001]

Quote:

Originally Posted by Phreddie Hmm this is tough, I would treat him, but I would like to do a slight reform of Insurance, if you drink, smoke, or other, you should be forced to pay higher insurance premiums, and pay a higher percent of your bills, due to you being a high risk customer, now the alcohol smoking, and 'other' industries (maybe not the others os much) would band together and block laws, but If poeple choose to destroy their health, and desecrate their bodies, then let them, but they have to apy a little extra.

Um, they do do that.

[Phreddie]

Oh, then Kudos... make em pay more! *bakc out gracefully*

I also think that when in the hospital smokers should be harassed by crazy extremists who are bombarding them with antismoking things, to the point they need a cig, but hey wont be abel to have one, this goes on until they can cope with out them, not that extrmee of course, but soemthing a little harsher than a nice rehab facility, something where they feel the need because of pressure, but are forced to learn to cope with it in different ways.

[Ravager]

Well, they ban smoking in hospitals generally and even make staff smoke outside if at all.
So, it wouldn't be easy to tell who smoked and didn't...well, okay, not blindingly obvious.

Like with Car Insurance the companies class people by the risk of how likely they are to need to claim and this can increase the costs for the person. Obviously smoking isn't going to work in favour regarding insurance costs.

[Lestat]

I'm an ex-smoker and I have several remarks:
- Free will? Hah, once you're hooked, you're hooked. Nicotine is one of the most addictive substances there is. I quit with difficulty, as did my sisters. When your at 15 a day it's not a habit.
- The guy is 60. If he started smoking in his youth that means he started in the 60's when the risks of smoking were very much downplayed and smoking was still considered very cool by society. To refuse him treatment now seems to me fairly hypocritical.
- If taxes on cigarettes are anywhere near as high in the US as they were in Europe when I quit, the guy is paying 40 to 50 USD per month in the coffers of the government (of course that money doesn't necessarily find its way to health care).

[Fenix]

Quote:

Originally Posted by Lestat To refuse him treatment now seems to me fairly hypocritical.

Well, the doctor is indeed 'treating' him, by offering a possible and probable solution to the cause, rather than just the symptoms.

[Lestat]

Well, if I read the article correctly, they are even refusing to see him, and wrote to advise him to stop smoking.

So if I write here "Hey stop smoking, all you SYM smokers", I'm treating them?

[VonDondu]

If you were told, "Your disease is caused by smoking and the only cure is to stop smoking," would you still insist on getting treatment from the hospital? The answer to that question frames this entire debate, and predictably, smokers who don't want to quit and those who are sympathetic to smokers take one view, and those who think people should quit smoking take a different view.

Quote:

The hospital spokesperson said: "To proceed with treatment whilst patients smoke gives the wrong message as it condones the habit. "This view is supported by recent guidelines from the National Institute for Clinical Excellence (NICE) and the Vascular Society."

I have mixed feelings about this. On the one hand, given the fact that health care is nearly always paid for by third parties either directly or indirectly, I think it's a waste of other people's money to treat a person who cannot be cured unless he stops smoking. And there is also the issue that health care resources are limited, so if one person receives a particular service, another person might be denied. (To take an extreme example, think of donor organs, which are certainly part of a smoker-vs.-nonsmoker or drinker-vs.-nondrinker debate.) A friend of mine died a few months ago because he wouldn't stop smoking. He was in the intensive care unit for about five weeks. Some people might have thought it was a bad use of limited resources, since other people needed that bed. The only thing the hospital could do for my friend was to make him more comfortable; a cure was out of the question. Did he deserve to be treated? In a limited sense, yes. He deserved to receive measures that would make him more comfortable before he died. But if he had lived, it would have been ridiculous for him to receive certain kinds of futile therapy if he wouldn't stop smoking, no matter how sympathetic someone such as myself might feel for his plight. A lung rehabilitation specialist would rightfully refuse to treat him since it would be a complete waste of time, money, and limited resources. To make an analogy, if there aren't enough doses of flu vaccine for everybody, it is good public health policy to give them to the people who would benefit the most instead of people for whom it wouldn't make a difference.

But on the other hand, I don't agree with the hospital's stated rationale. They don't take the logical/medical position that "treating a smoker is futile". Instead, they take the political/ethical position that "we need to send the right message about what we condone and don't condone". I don't think that's an appropriate argument for a health care organization to make, for one primary reason: the health care industry is not infallible. One of the main reasons why the friend I mentioned started smoking in the 1950s at the age of 15 is because his doctors encouraged him because they thought it would "calm his nerves". Obviously, the position taken by the doctors was wrong. To take another example, most doctors in the United States recommend circumcision, but in the future, they might reverse their position. So when doctors take a stand on ethical issues, I'm skeptical, and I don't want to give them final authority even if I agree with them. The health issues surrounding smoking are not really up for debate (except to people who are in denial), but the ethical issues about how smokers should be treated by doctors and hospitals are still open to debate, so I don't think it's right for a health organization to take a political stand that might be reversed several years from now. They need to stick with objective medical reasoning to justify their actions.

[Lestat]

Quote:

Originally Posted by VonDondu If you were told, "Your disease is caused by smoking and the only cure is to stop smoking," would you still insist on getting treatment from the hospital?

What I wanted to point out is that in advising him to stop smoking by letter they are not offering treatment, contrary to what Fenix suggests.
Of course we don't know the full extent of what is going on from the little info this article gives. Maybe they gave him the full options on how to quit or gave him a referral to people who could help him to quit, but this is not apparent from article. It suggests an outright refusal to even see the patient and confirm the diagnosis of smoking as the cause of his problem. What it suggest is that they are saying: "this problem is in the great majority of cases caused by smoking, so stop smoking, and if you still have the problem, then come back".

[VonDondu]

Lestat, I am not familiar with the hospital admissions process in any country. But to the best of my knowledge, hospitals admit non-emergency patients on the basis of physician referrals, so I assume that the man in question has already been seen by one or more doctors who believe that his condition was caused by smoking. I don't think the hospital is saying, "We don't treat smokers at all." I think they are saying, "We don't treat illnesses that are caused or exacerbated by smoking if the patient refuses to stop smoking." I could be wrong, though, so I don't know what else to say.

[Magrus]

I hate cigarettes with a passion. I do not smoke them, but I've always been curious as to how many cigarettes worth of smoke I happen to inhale a day. Most of my friends and family (90% or more) smoke, and therefore I deal with them smoking around me if I wish to have their company. If any one of them were smoking, went to the hospital with a problem, and it was true it was caused by smoking...I would expect the doctor to act as mentioned above. If my little brother went to the hospital for a broken leg, and the doctor refused to treat him because he smoked, I'd hire a lawyer and take his house if he still did not fix my brothers leg.

Getting away from the smoking thing, I drink a lot. I'm not an alcoholic, I don't drink every day, yet when I do drink, there are times I put away enough alcohol in a night that puts me at risk of alcohol poisoning. I know this, and yet, I still do so. If in the event I happened to have said risk occur, personally, I would not expect medical assistance. It is my choice to do what I do, and I recognize the possible risks and accept them. I am not ignorant, and I am not forced to do what I do. It is my choice, and I do not expect any doctor or anyone to pay for medical treatment for the results of that.

Also, I, myself, have provided what I would have to consider as the services of a therapist/psychologist. Unlicensed, voluteer, and only to those who know this as the truth of my situation. Anyone who comes to me for help is given my time and caring in seeing they get better. I have gone out of my way to see to it people didn't kill themselves, and in fact saved lives. Given those experiences...some people do not care what happens to them in what they do to themselves as long as they get to whatever goal they had in mind. If someone wants attention and pity, sometimes they are willing to do anything to get it.

Not only that, some people ask for help, and do not truly want to be "fixed". You cannot fix a person who does not want to be fixed. Someone who wants to die cannot be convinced to change their mind, not for anything, until they come to grips with something profound and on their own that is worth changing their mind. You cannot force someone to want to make themselves better. So, in light of my experiences dealing with young people who cut themselves, try to kill themselves, down household products for attention, yada yada yada...sometimes I've had to cut them off, and tell them I cannot under any circumstances help them unless I lock them in isolation so they cannot do such things.

Sometimes you must draw a line with those who seek help in order to truly help them to help themselves. I believe there should be a line. If, as Hill mentioned, you have a person who nearly killed themselves by smoking, and continued to smoke without a care in the world I wouldn't treat the person if he came back to me with a life-threatening problem directly caused by smoking if he refused to quit. Why? Realistically, no matter what you to the patient, if he is inflicting harm on himself, and refuses to stop doing so, no matter how many times you patch him up, he will still keep harming himself until he has a reason to stop.

After dealing with multiple suicide attempts with a friend of mine, and helping her through them, I gave up. I told her to call me if she wanted help to get away from such thoughts and avoid doing such a thing ever again. I told her not to bother coming near me in any way with another threat of suicide, or informing me she was bleeding and going to die. No matter how many times I rushed to bandage her up and call 911, she still continued to repeat her actions. No matter what I tried to do to help her, she continued to do so. The way I saw it, until she met me half-way, my time and effort weren't wanted and were being wasted. I can't imagine it being any different with a regular doctor. If you inform a person "what you are doing is causing your problems, quitting will help you get better" and the person rejects your advice time and time again, there isn't much you can do.

[Lestat]

Well, as I said, we do not have all the background info to judge the parties. As far as we know the patient might also be "shopping" around (i.e. refusing all advise from subsequent physicians until he finds someone who wants to give him the treatment he feels he's entitled too).

[Georgi]

Quote:

Originally Posted by fable Is the patient being treated via a public medical program? Because if so, I suspect this is controlled by a series of procedures. If it's a privately owned medical facility, then presumably the hospital and the physicians separately could set their own guidelines for this kind of matter.

Yes, it is via the National Health Service. Just think, if he quit smoking, he could probably afford to pay for private healthcare.

I don't really have much sympathy for the guy, but it does lead to a slippery slope. Should doctors refuse to treat fat people with heart conditions (or whatever) unless they go on a diet? Refuse to treat heavy drinkers with liver disease? I'm sure the examples are endless... but hey, it would cut down on the waiting lists, I'm sure it's on Tony's list of new year's resolutions.

[Craig]

I tihnk its fair enough, apart from it being 6 months, if things don't improve in 2 then they should ge the opp, and some free nicotene patch vouchers, to say sorry, y'know?

Vouchers solve everything

[boo's daddy]

Hello and squeak.

An interesting discussion, lots of good points made. Some key points from my smoker's perspective are:

- nicotine is ten times more addictive than heroin. The majority of smokers want to stop but can't.
- as I think DJ venom said, if you want people to stop smoking, give them positive help, don't try to kill them by withholding treatment.
- in the UK we contribute around £9bn in taxes on tobacco; the NHS budget is around $90bn; I think we've already paid for our treatment.
- would they refuse to treat an injured mountain climber unless s/he undertook to give up mountain climbing?
- the doctors in this case they are being monumentally arrogant and I hope the guy sues them to the stone age. They are (supposedly) employees of the NHS, funded by the public, yet they feel morally empowered to lord it over patients in this way.

The only justification could possibly be on clinical grounds: i.e. the treatment would not work if they guy carried on smoking. Saying that the treatment would be LESS EFFECTIVE if he carried on smoking is not the same thing. It might well still save his legs and/or life.

[RedDragon7175]

some kneE jerk reactions here. This guy has atheromatous disease causing claudication in his legs. it's not unreasonable to put conditions on his treatment, similar to alcoholics being made to be booze free beforr liver transplants. There is a limted budget in each trust within the NHS in the Uk (for those aoutside the UK, in general you pay for your health care via taxes, and any health care you receive is essentially free apart from fixed price prescriptions- meaning someone on benenfit gets exactly the same treatment as rich people- no such things as HMOs here!)