Should smokers be refused elective surgery? The British Medical Journal features a vigorous debate on this burning issue. An Australian, , of Concord Repatriation Hospital, in Sydney, says Yes. He contends that with finite resources, preferring non-smokers over smokers "will deliver greater clinical benefit to individuals and the community". He cites a plethora of statistics which indicate that smokers are far more prone to complications and require longer hospital stays. "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," he says.

However, , a bioethicist at Boston University School of Public Health, says No. He counters Dr Peters’s statistics with jabs at the inconsistency of his principles. Doctors have always believed that they were obliged to treat pariahs with the same care as other patients, whether they were enemy troops, terrorists — or smokers. Furthermore, the principle at issue seems to be that patients should be obliged to get healthy as a condition of receiving treatment. But many non-smokers cost society money because of sporting injuries — 488 million days of productivity in 2002. "Indeed, if we treat a sports injury that person is likely to risk incurring future costly sports injuries. But we don’t even think this, let alone suggest it." He concludes that "it is shameful for doctors to be willing to treat everybody but smokers in a society that is supposed to be pluralistic and tolerant."

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Michael Cook

Michael Cook edits BioEdge, a bioethics newsletter, and MercatorNet, an on-line magazine whose focus is human dignity. He writes from Sydney, Australia.

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