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Smokers test case in medical discrimination, fat people next, then lazy ones...

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Home > Specials > Health > Article
Surgeon urges lower priority for smokers

By Michael Bradley
April 5, 2004

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Smokers who do not quit should be refused elective surgery, argues a Sydney doctor who says post-operative infection rates are higher for smokers and that their treatment wastes healthcare resources.

In an editorial in today's Medical Journal of Australia, Matthew Peters said patients must stop smoking at least six weeks before surgery, as research had shown quitting three weeks before has no benefit.

"Public heath systems are faced with overwhelming demand and must generate the greatest benefit from limited resources," said Dr Peters, head of thoracic medicine at Concord Hospital. "Continued smoking in the face of elective surgery increases the risk to the individual and stretches already stretched healthcare resources and expenditure unnecessarily. The community has to decide whether this is justified."

But his suggestion that smokers be given lower priority has raised concerns among some surgeons.

The head of the department of surgery at the University of Sydney, Professor John Fletcher, said: "There is no doubt the risk of post-operative complications is higher in patients who smoke, and certainly the optimum would be for smokers to cease six weeks before surgery. But some patients, no matter how they try, just can't get off [cigarettes] completely and we have to take that into consideration. I think it would be unfair."
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Associate Professor Stephen Gatt, program director of anaesthesia and intensive care for the Prince of Wales Hospital and the Children's Hospital at Randwick, said: "I think it is desirable people stop, but I don't think it's practical to tell people you will not operate on them if they don't. We can't discriminate against those who smoke."

It is widely believed higher levels of carbon monoxide and other chemicals in a smoker's blood decrease oxygen supply to body tissue and impair a wound's capacity to heal.

Dr Myles Coolican, an orthopaedic surgeon at Royal North Shore Hospital, said he insisted that a patient stop smoking 12 weeks before surgery for operations needing a high degree of healing and the cutting of bone.

Yet for other, more minor procedures he saw no need for smokers to quit at all. "There is no question that complications are greater in smokers because they don't heal as well or as quickly and infection rates are higher," he said. "You have to suggest they give it up, but in the finish, it's not me who gets the infection, it's the patient. All you can do is tell them the risk."

Dr Peters said his critics "have their head in the sand" if they believed individual smokers were the only people whose rights needed to be considered. ". . . You will certainly do more good for more patients if you only operate on non-smokers."

Original source.

"Listen sir, your grandma didn't live a very healthy life. Now she has a lot of medical problems in her 80s, that frankley, require a lot of care. Because we have to consider the rights of more than just old people, we're going to let her die."
Granted, that's extreme, but it's where this train of thought ends up.

The idea that you may not care for my smoking has occurred to me. That's why I take great pains to save the hordes of sanctimonious non-smokers from my secondhand smoke. The idea that someone would actually condone not granting me medical care is a bit much for me to consider.
Given the trend over the past 20 years, of making the logical fallacy "slippery slope" a reality, I think fat people are next.
Obesity has risen over smoking as the number one killer, so if someone can (with a straight face) deny a smoker medical care because they contend that a smoker's care is more expensive, than it's certainly no stretch apply the same logic to the obese.
Or, it could be applied to someone with high blood pressure that the doctor says comes from .... whatever.

This is not a good idea.

I'd also like to rebut the good doctor on smokers costing more.

That may possibly be true, but smokers pay more, so shove off.
I have to check the "smoker" box, which raises my insurance rates. I pay for my habit in more way than one.
I also pay more taxes than a similar non-smoker. Everyone needs to remember that almost every state raises taxes on smokes and booze as soon as there is a budget issue. Smokers often pay for more than their share.

Smokers who do not quit should be refused elective surgery

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I SWEAR by Apollo the physician and Æsculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgment,

I will keep this Oath and this stipulation — to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction,

I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others.

I will follow that system of regimen which, according to my ability and judgement, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous.

I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. With purity and with holiness I will pass my life and practice my Art.

I will not cut persons labouring under the stone, but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further, from the seduction of females or males, of freemen and slaves. Whatever, in connection with my professional service, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad,

I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times. But should I trespass and violate this Oath, may the reverse be my lot.

The good doctor might wanna re-evaluate the oath he once took.

Lets deny treatment for the elderly too, health care only puts off their inevitable demise.
While we're at it, no health care for children either. They don't do anything to earn their keep, and who knows, the child may grow up to be a smoker.
We shouldn't waste our resources on poor people or immigrants either.

[/sarcasm]

Public health care means it's public, either offer it equally to everybody, or go private.

you make choices you live with consequences.

while you may have to pay higher premiums and insurance companies may even eventually elect to NOT cover certain things caused by those choices one makes, then I have no issue with something like this.

A great example of this PRIORITIZING is if you go to the ER and you are just complaining of a stomach ache or back pain. Sure they will see you, eventually. All the other people who are immediately life threatening will find themselves in front of you.

Make choices about your life, accept the responsibility that other people will also make choices and judgements about the choices and lifestyle you chose.

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Smokers who do not quit should be refused elective surgery, argues a Sydney doctor who says post-operative infection rates are higher for smokers and that their treatment wastes healthcare resources.

Granted, smoking is a very big health risk. My dad has been smoking for 25 years, and he's in terrible shape because of it. It's also a waste of the family money, with all the damn taxes.

But that's not what the doctor is arguing. He is arguing that it weakens the immune system. Smoking is just ONE of the countless factors that can affect one's immune system. The factors include diet, exercise, drinking, environment, etc. They might as well refuse elective surgery to people who live in polluted cities.

Good thing it's just one doctor, who lives all the way in Australia. I hope there's no such talk in the US.

We have got to figure out a way to tax self righeousness. Really. Dead serious. We figure that out and this wouldn't even be an issue, because we'd be looking for things to spend all the money we'd make on.

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Originally posted by Tophat665
We have got to figure out a way to tax self righeousness. Really. Dead serious. We figure that out and this wouldn't even be an issue, because we'd be looking for things to spend all the money we'd make on.

That would surely bankrupt all the christians.

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Originally posted by kutulu
That would surely bankrupt all the christians.

*sigh*

Thanks for the insult.

that doctor thinks in solely black & white.
the many shades of grey in between do not exists for him.

what a putz.
fortunately, i don't believe his suggestion will likely catch on.

Well.. what proof do they have that I smoke? I'll just say I don't. The smell? My wife smokes... my breath? I kiss my wife. These cig's? I carry them for my wife.

Honestly... This is like saying we shouldnt waste education on the mentally challevged because their learning is greatly slower then those who are not.

And... Last I checked... my health insurance is payed up.
Just do your fucking job like the rest of us in the world.

the key word here is ELECTIVE SURGERY. ELECTIVE ELECTIVE ELECTIVE.

I dont really support the idea propused, but because the surgery is elective, the way I understand it a doctor can refuse elective surgery on any ground he wants.

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Originally posted by Tholo
the key word here is ELECTIVE SURGERY. ELECTIVE ELECTIVE ELECTIVE.

I dont really support the idea propused, but because the surgery is elective, the way I understand it a doctor can refuse elective surgery on any ground he wants.

i know a plastic surgion in florida who refused to perform that elective surgery on a trial lawyer does that seem wrong to you,

i have heard this idea from a few doctors around here that they should request the court cases filed under medical malpractice and determine if it was necisary if it was not refuse to see the patient for elective reasons if there something life threatoning you would still see them

the hipocratic oath only requests that you do not harm the patient and you do everything in your power to help them survive, it says nothing about helping them appear better in any way

also it says that they will not perform abortions but we know that every doctor follows that line under all surcimstances ;)

The truth is that smokers and obese people DO make health insurance more expensive for the rest of us. Not that I condone this doctor's idea, but let's be real here.

If its elective surgury only, then I have no problem. If the insurance rates are higher... good, they ought to be. If one day insurance refuses to cover damage done by smoking, fine by me.

My warantee on my car gets thrown away if I do stupid shit to it, why should healthcare and insurance be any differant?

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Originally posted by Derwood
The truth is that smokers and obese people DO make health insurance more expensive for the rest of us. Not that I condone this doctor's idea, but let's be real here.

You know who else makes health care more expensive? Parents.
Yep - parents. Because children are always getting sick and taking up doctors' precious time. And if that wasn't bad enough, every time a child gets sick, the illness is passed on to their parents, and their parents' coworkers, and those coworkers' spouses, and their kids - which starts the whole cycle over again. Each one of those little buggers is a miniature Typhoid Mary.
Having children is a conscious choice with dire circumstances. It puts a tremendous strain on health care, and should be outlawed.
:)

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Originally posted by billege
I also pay more taxes than a similar non-smoker. Everyone needs to remember that almost every state raises taxes on smokes and booze as soon as there is a budget issue. Smokers often pay for more than their share.

I think the most outlandish example of this is the new stadium built in Cleveland about 7 years ago. It was built from funds collected on a 50 cent per pack cigarette tax. And can smokers smoke in "their" new stadium - even though it's outdoors? Of course not.

/not a smoker; just don't agree with discrimination against legal practices.

<b>Edited later:</b> I will, however, agree with the doctors who request (or require) that their patients stop smoking for a certain time period before surgery - unsuccessful surgeries and complications can affect doctors' reputations (and income) as well as the patients' well being.

Re: Smokers test case in medical discrimination, fat people next, then lazy ones...

The keyword here is "elective". That means, it's not required for the person to continue living. As such, it seems to me to be an arguable point whether it should be done at all, for anyone, unless they pay out of pocket.

Shoot myself in the foot by mentioning his name, but anyway:

...then Hitler came for us, and there was no-one left to help.

(or some such quote)

You get the point, though:

Where will it stop if they are allowed to be less than universal?

no smokers
no alcoholics
no overweight people
no extreme sports participants
no standard sports participants
no people who go to the gym less than three times a week and fail in their duty to eat a strict diet regulated by a dietician
...
no seriously ill people
no ill people
no-one who needs it and can't pay for it themselves...

Yeah, it sounds far fetched, but would anyone have thought that smoking could be banned in public places 30 years ago?

Once a precedent is set, things tend to creep.

I'm not a smoker, but i do believe in freedom.

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Once a precedent is set, things tend to creep.

The precident is about elective surgury.

Basically, this doctor and hospital gets the same money if you smoke or not, and the load on the health care system and on the doctor is higher if you are a smoker.

If a doctor wants to not treat lawyers for cosmetic surgury, more power to her. Her freedom to not operate is as important, or more so, than the lawyers freedom to get cosmetic surgury.

Now, if the AMA decided, en-mass, they wouldn't treat lawyers, that would be a qualitiatively different thing. Because now you would have the law saying "you can only get cosmetic surgury from the AMA, and the AMA says you cannot get cosmetic surgury from them."