The latest health organization to make that decision is NHS Fife in Scotland, but several other Scottish groups have already put similar restrictions into effect or are planning to do so. Indeed, similar restrictions were introduced by NHS Lothian in 2010.
Medical restrictions on smokers are nothing new, enjoy considerable support among physicians, and have been in effect for many years, says Banzhaf, who has been called "Mr. Antismoking,"
A 2012 report showed that a majority [54%] of doctors in the U.K. support measures to deny treatment to smokers and the obese, that smokers and obese patients are already being denied certain operations, and that more than a quarter of primary care [health] trusts [PCTs] have adopted treatment bans for those groups within the past year.
Indeed, even five years earlier, smokers were being denied certain operations unless they gave up cigarettes for at least four weeks, a policy authorized by the Health Secretary.
In 2008, it was reported that 10% of U.K. hospitals were denying some surgeries to smokers, and that "a growing number of doctors apparently approve, arguing that patients have responsibilities as well as rights. These include responsibilities to care for their own health."
This policy was supported by an article in the British Medical Journal arguing that smokers should be refused elective surgery unless they quit smoking for at least one month. Banzhaf notes that a ban on certain surgeries for smokers was in effect as early as 2001 in Australia.
Years earlier, several U.S. physicians argued in favor of denying certain operations to smokers, arguing in a published article that "it may even be in the public interest to deny renal transplantation to patients who do not make a serious attempt to quit smoking. The interests of both the individual and society may be best served by such an approach."
In most situations, smokers are denied certain treatments because their refusal to quit smoking makes the success of the operation problematical or, in the case of an OB/GYN practice, makes giving birth more dangerous for both mother and child.
Doctors may well not wish to assume these added risks – and possible law suits and/or potential legal liability if things don't go well – if patients are not willing to take steps to improve their own health.
In addition to denying treatment in certain situations to smokers or the obese, another approach has been to charge them higher premiums for health insurance. Beginning in 2014, the Affordable Health Care Act authorizes charging smokers 50% more for their health insurance than nonsmokers, even if the employer does not have a wellness program in place.
JOHN F. BANZHAF III, B.S.E.E., J.D., Sc.D.
Professor of Public Interest Law
George Washington University Law School,
FAMRI Dr. William Cahan Distinguished Professor,
Fellow, World Technology Network,
Founder, Action on Smoking and Health (ASH)
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