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Posted: **Mon Dec 19, 2005 6:00 pm**

[url="http://news.bbc.co.uk/1/hi/england/lincolnshire/4543664.stm"]Linky.[/url]

A Lincoln man has criticised a hospital which is refusing to treat him until he stops smoking.
Lincoln County Hospital has told Frederick Smith, 60, he must give up his 15-a-day habit for six months before he can be treated.

Mr Smith said the narrowing of the arteries in his leg could be caused by a number of things, not just smoking.

But a spokeswoman for Lincoln County Hospital said treating smokers sent out the message they condoned the habit.

Mr Smith said: "All I want to know is what is causing this.

Who's to know I could be in a wheelchair in six months' time. Perhaps unable to walk, maybe even lose a leg, or even my life.

"It would cost far more to put that sort of problem right than seeing me now."

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."

Surgeon Andrew Lamerton wrote to Mr Smith advising him to stop smoking: "Giving up smoking may lead to an improvement in a patient's symptoms.

"Unless the condition was limb-threatening this would always be the preferred option and the best course of action for the patient, helping them to avoid medical or surgical intervention."

Mr Lamerton said that in 75% of patients who take his advice and stop smoking for six months there is an improvement in symptoms and no other treatment is necessary.

Thoughts? Comments?

Posted: **Mon Dec 19, 2005 6:05 pm**

Since when is it for doctors to "condone" anything. That makes me sick

Posted: **Mon Dec 19, 2005 6:13 pm**

A little anecdote. As some of you know, I am not the only microbiologist in my family, my mother is one as well. She told me a story of a smoker who had to have hus lung removed. After that, he continued smoking. I could not believe that this man, living off of one lung, as still continuing to smoke.

That was a little over a year ago. She is expecting to see him walk into the doors of the first floor clinic anytime soon at the Cancer Center.

He is wasting the money of the Canadian people on this habit. We can not replace his lung. Nor would we wish to. If we could, it could have been used for someone who had need of it, not a person who would blacken it in a year, and be back in the hospital, trying to get another one.

Posted: **Mon Dec 19, 2005 6:14 pm**

Doctors should treat him despite his smoking habits, even though helping him with stopping the habbit should be achieved during the treatment, not as a condition for treatment... heh strange people, doctors. They put carrots on your bloodstream via your arm and use those strange amnesthesic needles to put you to sleep an listen to queen while operating you. "we are the champions" may help that small arteries man to recover. And hell, whatever, the guy should have stopped smoking a long time ago, and the doctors should be happy with him smoking, cause he'll return, and they'll earn more. Yes. Damn, humanity.

Posted: **Mon Dec 19, 2005 6:20 pm**

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.

I can't say how it works in the UK, but in the US we do have physicians groups that will refuse to treat smokers for certain ailments, just as there are some insurance companies that will exclude these treatments if its known the insuree is a smoker. The incident of continuing damage to the lungs by tobacco smoke, for instance (leaving aside all the other problems it causes) is such that my current pulmonologist won't see a smoker. Period. Unfair? Perhaps. But this is a decision many physicians must make, given the overload of patients. If you had to choose from a large number of people to see as regular patients, it stands to reason that those with a vested interest in fixing and maintaining their own health would receive preference.

Posted: **Mon Dec 19, 2005 6:22 pm**

Well, I'd say it was one way of getting people to have healthier habits before a treatment, but at what cost?
Aren't there medical oaths that a patient is to be helped in any case if possible?
Also there is no guarantee that a patient couldn't just recur into those unhealthy habits that may have caused a condition in the first place.

In such cases I believe there if a condition could be improved by stopping an unhealthy habit then the patient should be informed and encouraged to stop that habit, but not to the effect of witholding a treatment which could be potentially fatal to the patient.

Of course, to play devil's advocate, if patients who are serious about recovering are treated over those who aren't that may encourage a better general attitude among patients.

Posted: **Mon Dec 19, 2005 6:25 pm**

[QUOTE=Ravager]Well, I'd say it was one way of getting people to have healthier habits before a treatment, but at what cost?
Aren't there medical oaths that a patient is to be helped in any case if possible?
Also there is no guarantee that a patient couldn't just recur into those unhealthy habits that may have caused a condition in the first place.

In such cases I believe there if a condition could be improved by stopping an unhealthy habit then the patient should be informed and encouraged to stop that habit, but not to the effect of witholding a treatment which could be potentially fatal to the patient.

[/QUOTE]

Yes

Posted: **Mon Dec 19, 2005 6:30 pm**

Aren't there medical oaths that a patient is to be helped in any case if possible?

That depends. 'Salus aegroti suprema lex'*. Is it in the best interest of the patient to continue smoking?

There are no guarantees that if you continue smoking you will not fet the same illness. In fact, you still have a high chance, and an even higher chance of getting other diseases.

*What is in the best interests of the patient

Posted: **Mon Dec 19, 2005 6:31 pm**

[QUOTE=Hill-Shatar]Is it in the best interest of the patient to continue smoking? [/size][/QUOTE]

What about free will?

Posted: **Mon Dec 19, 2005 6:32 pm**

Well the article says that "Mr Lamerton said that in 75% of patients who take his advice and stop smoking for six months there is an improvement in symptoms and no other treatment is necessary", so it's quite obvious that a lot of people have been told what he's been told, but he's just causing a fuss.

Posted: **Mon Dec 19, 2005 6:37 pm**

Luis Antonio wrote:What about free will?

Free will? This person thinks that it is in their best interests to continue smoking and use the health care system to have surgery and the like to repair damage, until eventually he develops a disease that is lethal?

They have the right to choose the treatment they want. The selection is the one that Doctor's put forth. You would not want to choose foot surgery for a broken arm, would you (yes, I know, not a great example) but my point is, if the Doctor thinks that nothing can be gained from this, and that it shows that you can smoke and those in medicine can pick up the slack, than is it really in the best interests of this patient?

This is not if the patient is interested, per se. This is somewhat like Plastic Curgery: It has uses for those burned in fires and the like, but some call it a disgusting use of time and medicine if a person goes in to get her nose to look slightly more curved. It is condoned, however, and is that the best way for human's (in my opinion, as you can see, so far)? Should we condone smoking?

Well the article says that "Mr Lamerton said that in 75% of patients who take his advice and stop smoking for six months there is an improvement in symptoms and no other treatment is necessary", so it's quite obvious that a lot of people have been told what he's been told, but he's just causing a fuss.

Exactly, you can see a very good example here. They stop smoking, and they have a good chance of getting better. If they stop and nothing improves, than they can still get surgery and not worry about future problems from the habit.

Posted: **Mon Dec 19, 2005 6:43 pm**

Ok, there ya go.

A friend of my family is dying because of alcoholics. He's stubborn and wont give up on drinking. Public service will treat him because by force of the law they cant deny him treatment. Its the fourth time he goes to the hospital, they stuck a thing in his arm, he is drained out from liquid that accumulates on his belly and, after every doctor says he's about to die, the man gets up again and, after a month of treatment, he starts drinking all over again.

Is it the optimal thing? No.

Denying him treatment is a solution? yes, if you're a lawier and you want to sue the hospital, the union and everyone else who saw him on the hospital wing.

So, what do we do? Its his choice. He chooses death - so he's gonna receive treatment, its gonna be expensive. Good thing he's on the news. He's an <insert offensive word here> who's complaining, maybe young people will look at him and see how dumb he is and will avoid starting smoking in the first place. But he has free will, the drug he uses is commercially accepted, and the doctor has nothing to do with it if he wants to keep smoking.

Posted: **Mon Dec 19, 2005 6:50 pm**

I do not think the Canadians government allows doctor's to refuse to treat patients. We treat anyone for any reason, as long as they are covered by medicare, universally avialable for Canadians accross the country, and it is payed through taxes.

My grandfather died of a pulmonary disease, known as Farmer's Lung. His lungs were essentially swiss cheese. They finally got him into the hospital, which he was dreadfully scared of going to, after my grandmother pleaded with him for hours.

He died two days later, at 3 in the morning, after talking with my mother to see how the farm, a place he rarely went more than thirty kilometers away from, was doing. It was his choice to refuse treatment. I wish he could have been around longer, but his fear of doctor's was too great.

Posted: **Mon Dec 19, 2005 8:08 pm**

I HATE smokers. I don't hate them personally, I just think it's a disgusting habit and I cannot stand to be around them. But, as much as I don't like the habit, I do believe this guy should gain treatment.

He has chosen to smoke, and although it's dangerous for his health, it's his choice of what he wants to do. Now, it seems everyone is okay with that, however most of you are against him wasting the tax money.

Well he is paying it back, I assure you. If the rest of the world is like Australia, then smokes are heavily taxed. As a result, whether or not it is realised, but by smoking 15 a day, he is paying large amounts of tax. So this is paying for the health money, and if he dies, well the government loses money, so it's in their interests to keep him alive.

Now, while he should be treated, I don't think he should be able to walk out straight after. He should be sent quit smoking meetings, and him and his family should be shown scary pictures of what smoking can do. They should get this guy to quit.

So if we refuse him treatment, he could die. Or we could ensure him treatment, try to better his lifestyle, and let him enjoy his later years.

Posted: **Mon Dec 19, 2005 8:58 pm**

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.

Posted: **Mon Dec 19, 2005 9:01 pm**

[QUOTE=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.[/QUOTE]
Um, they do do that.

Posted: **Mon Dec 19, 2005 9:04 pm**

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.

Posted: **Mon Dec 19, 2005 9:16 pm**

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.

Posted: **Tue Dec 20, 2005 2:50 am**

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).

Posted: **Tue Dec 20, 2005 9:15 am**

[QUOTE=Lestat]To refuse him treatment now seems to me fairly hypocritical.
[/QUOTE]

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

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Smoker refused treatment.

Smoker refused treatment.