Medical professionals, including a Boston University School of Public Health professor, debate an Australian physicians’ public support of a clinic’s decision to deny smokers a spot on surgery waiting lists.
In the Jan. 6 British Medical Journal article titled “Should Smokers Be Refused Surgery?” associate professor Matthew Peters of Concord Repatriation General Hospital in Australia said smokers who refuse to quit should be excluded from surgery because of the higher infection risk associated with smoking.
In the article, BU professor Leonard Glantz, the SPH associate dean, said denying surgery to smokers discrimination and violates medicine’s duty to treat its patients.
“Medicine has always been about single-minded devotion to patients,” he told The Daily Free Press. “Doctors have always treated people who are rejected by society, like murderers or terrorists. We do not discriminate against any other group.
“If we are going to start dealing with people as a group, and . . . deny surgery to smokers, then why shouldn’t we say the same for skiers, drinkers or fat people?” he continued.
Glantz said denying patients’ rights and depriving them of surgery goes against one of the medical field’s most basic rights of caring for a patient, particularly if the definition of a smoker is questionable.
“Being a smoker is something indefinable in medical terms,” he said. “I can answer what a woman is in medical terms, but not a smoker. What is a smoker? Someone who smokes two cigarettes or two packs a day? If this so-called underclass of people cannot be defined, how can we say we are not going to treat that group?”
Failure to quit smoking before certain surgeries increases the costs of care for the hospital treating the patient and affects the patient’s outcome after the surgery, Peters said in the article.
When a patient undergoes surgery for cosmetic purposes, the risk of wound infection for a smoker is too high and the surgery “would be illogical,” he said in the article. With other surgeries, such as reconstructive surgery, smoking increases health risks, he said, and unless the reconstruction cannot be delayed, it is better not to offer it to a patient until he or she has stopped smoking.
Peters cited medical studies in the article, comparing indirect costs of treating smokers and non-smokers, noting that “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.”
Glantz said surgery costs can be applied to other groups besides smokers, such as athletes with sports injuries.
“We could reduce health expenditure by simply refusing to pay for treating any injuries related to voluntary participation in sports,” Glantz said in the article.
“The same could be said about old people,” he said. “Does treating old people cost more than treating young people? . . . Do they take longer to heal and with less success? In that case, is it fair to say that old people should be refused surgery?”
BU smokers and non-smokers said the issue could not be justified in general terms but rather on a case-by-case basis.
“I would say that when it comes to a lung transplant, it would be wrong to give a new lung to someone who ruined it by smoking in the first place,” said College of Arts and Sciences sophomore Lauren Slaughter, a non-smoker. “But, when it comes to general surgery, you can’t deny someone medical care just because of their lifestyle.”
Glantz said he agreed with Slaughter’s opinion and posed further rhetorical questions about the issue.
“It is very different to refuse surgery to someone who does not fulfill a certain medical requirement,” he said. “Take heart disease. It is not the same to say that a person cannot receive or withstand surgery because of their heart condition than to say that people with heart conditions should not have surgery.”
CAS sophomore Samantha DiPalma, a smoker, said if there are extra costs, it should concern the smoker, not the medical professional, on the patient’s health outcome.
“If they tell you about the possible risks, and you agree to undergo surgery, then it is your responsibility and your choice,” she said. “It is also you who is paying for the elective surgery most likely, so it’s up to you whether or not you do it.”
For Peters, the cause of a disease should not be an issue for debate. According to his article, “individuals should be treated equitably regardless of the cause of their disease,” however, smoking is unique because the associated risk “can be reduced substantially within a short period of time.”
“It is a general issue of equity,” Glantz said. “We can’t treat everyone except smokers. That is not justified.”