[Intl-tobacco] Australia: Smokers' surgery ban comes under fire (fwd)

[Robert Weissman]

Smokers' surgery ban comes under fire
by From The Herald Sun and AAP
Source: (Southbank, VIC) Herald Sun, Thursday, 2/8/01

A DECISION by some Melbourne surgeons to withhold treatment from smokers
who refuse to quit brought criticism from both human rights and medical
bodies this afternoon.

Physicians and surgeons at the city's top hospitals told the Herald Sun
they are denying smokers treatment such as lung and heart transplants,
lung reduction surgery, artery by-passes and coronary artery grafts.

But the Human Rights and Equal Opportunities Commission said today smoking
is not grounds for discrimination under federal anti-discrimination laws.

And the Australian Medical Association said it was "unconscionable" for a
surgeon to take a moral stand when deciding whether to treat a patient.

Alfred Hospital respiratory physician Associate Professor Greg Snell told
the Herald Sun the reasons for the ban were medical and moral.

"There's not enough health dollars to go around," he said.

 "It is within our mandate to ration services and smoking is one way to
define the patient population.

 "It is common practice to not do elective surgery, and certainly some
lung operations, on people who smoke."

 Austin and Repatriation Medical Centre senior respiratory physician
Associate Professor Lou Irving said it was left to each doctor how to deal
with smokers.

 "Why should taxpayers pay for it? It is consuming resources for someone
who is contributing to their own demise.

 "We'd be better off putting the money into the prevention and treatment
of tobacco addiction."

 Prof. Irving said he knew of many vascular and cardiac surgeons who would
refuse treatment based on a patient's smoking status.

 "My policy is to very strongly discourage smoking and to encourage them
to quit because smoking will reduce the effectiveness of the treatment,"
he said.

 "I would not give treatment if I felt on-going smoking would make the
risk of the procedure too great."

 Alfred Hospital patient Steve Marwick admitted yesterday that not even
multiple injuries from a car accident could stop his craving.

 "I know the people at the hospital are right but it's a pretty hard thing
to give up," he said after sneaking out to smoke.

  Prof. Irving said strong scientific evidence had shown smokers risked
complications such as lung infections during operations requiring
anaesthesia.

 Austin policy meant smokers were strictly denied long-term supplemental
oxygen to improve blood oxygen levels because it was too dangerous.

 Prof. Irving said it disappointed him when patients refused to help
themselves in avoiding tobacco-related diseases.

 The Alfred's criteria on eligibility for lung transplants require a
patient to have been smoke-free at least six months.

 It says candidates must have been free of all substance addiction -
including alcohol, tobacco and narcotics - for six months.

 Prof. Snell said many other specialist treatment units, including heart
and vascular, had more informal criteria.

 Austin director of vascular surgery Andrew Roberts said research had
proved smoking was risky in many types of surgery.

 He said studies had shown the long-term results of bypass reconstructive
surgery in smokers was deplorable. Unless someone risked losing a limb to
gangrene or ulcers, he would refuse to perform the operation.

 "Most vascular surgeons will not operate because they know the operation
is likely to fail."

 Royal Australasian College of Surgeons president Bruce Barraclough agreed
some surgery was futile for smokers.

 "Lung reduction surgery, for example, where the problem has been caused
by smoking, well, there's not much point doing something that is
life-threatening if the patient continues to smoke," he said.

 Director of the Murdoch Childrens Research Institute ethics program
Julian Savulescu said singling out smokers was inconsistent. Many
illnesses could also be blamed on a patient's lifestyle, such as obesity
and heart disease.

 "In principle, the idea of making people responsible for their illness by
paying for the consequences of their actions is attractive to some," he
said.  "But in practice it will ultimately lead to selective
discrimination."

 He said smokers theoretically paid for extra health care costs through
tobacco taxes.

A spokeswoman for the Human Rights and Equal Opportunities Commission said
it had received no complaints from smokers against hospitals about a lack
of treatment.

She said if complaints were made, they would be looked at individually.

The AMA's Victorian president Michael Sedgley said while medical
practitioners regularly made health judgments, it was "unconscionable" for
a surgeon to take a moral stand when deciding whether to treat a patient.

"I don't think we as a profession are able to judge patients," Dr Sedgley
said.

"We are incumbent under the World Health Organisation definition of health
to accept that health is more than just the absence of disease."

He said to make a decision on moral judgments rather than health was
"outrageous".

"There are situations where smoking causes complications with surgery
(and)  doctors are quite entitled to make judgments on health grounds," Mr
Sedgley said.

However, he said it was up to doctors to warn smokers about the dangers.

"If people take the decision (to smoke) they have to take the
responsibility,"  he said.