Should Smokers be Denied Surgery?

What an irony: On one hand, society is getting pretty libertarian. We are not to judge or shun each other for personal behavior. On the other hand, this injunction does not apply to smokers, who can be castigated from here to Timbuktu. Add in the growing utilitarian emphasis being promoted by bioethicists and others within the medical intelligentsia, and viola, we have a new form of medical discrimination unfolding before our very eyes:

In the UK, in the British Medical Journal no less, a medical professor urges that smokers be denied some surgeries: "Increased use of hospital beds and associated costs mean less opportunity to treat other patients. Based on these data, five non-smokers could be operated on for the cost and bed use of four smokers and the non-smokers' surgical outcomes would be better. A well informed smoker, unwilling or unable to quit, might assume an increased risk for himself, but the decision is not his alone when it can indirectly affect others. Then, the community must involve itself."

I am willing to bet that this professor would never say that promiscuous people who engage in risky behaviors be denied surgeries or other forms of medical care, even though they may contract diseases that affect outcomes and take up beds. (For example, just today it was announced that a virulent, drug resistant staph infection can be spread by sexual congress--surely a matter of distinct concern at a time when many hospitals have problems with staph infections spreading among patients.) He probably would move quickly, however, to promote similar discrimination against the obese.

Once we countenance explicit health care rationing--which is what this proposal advocates--those discriminated against will be patients in unpopular categories with little political power. Those with political power, real or perceived, will never be the ones whose health is deemed to matter less.

This is precisely the point madey by the author of a reply article, also in the BMJ. "Discriminating against smokers has become an acceptable norm. Indeed, at least one group of authors who believe smokers should be refused surgery blithely admits that it is 'overtly discriminatory.' The suggestion that we should deprive smokers of surgery indicates that the medical and public health communities have created an underclass of people against whom discrimination is not only tolerated but encouraged."