Editorial: No right to kill yourself in hospital

Why has it taken the district health boards this long to ban smoking in their buildings, vehicles and grounds? The boards might previously have answered that it saw no reason to move ahead of the general law, which allows smoking in designated areas of premises open to the public. If so, they have now changed their minds. All 21 of the country's boards have agreed to ban smoking entirely from their property by next May when they observe a World Smokefree Day.

The Auckland board will institute the ban a week from tomorrow - and, it seems, not a moment too soon. Since December, Auckland Hospital has generously provided wooden gazebos in its grounds for smokers who would otherwise congregate at hospital doorways, stairwells and loading bays. From next week they will be out on the street. Across the bridge, however, Waitemata Health Board is some way behind. It is about to set up designated smoking areas in its hospital grounds. "They will be pushed nearer and nearer the boundaries and ultimately not be on the site at all," says a spokeswoman. Why so slow?

It has been ludicrous that the public pays for the repair of people only to see them indulging in a plainly health-threatening activity while they are still in hospital. This isn't an attack on individual freedom, it's the hospital saying, "Look, we're not going to contribute to your decline while you are in our care. What you do when you're discharged is your business. While we are treating you here, it's our business."

It must be soul-destroying for a heart specialist to walk through a hospital and find his patients puffing away when he knows - and they should know - that smoking is a cause of heart disease. We think nothing of the hospital imposing a dietary regime while patients are in hospital. Why should smoking be beyond their control?

Smoking is addictive, of course, in a way that dietary habits are not. An enforced abstinence for a period in hospital might not make much difference to a lifelong habit. On the other hand, it just might make the difference. To land in hospital for any reason is a shock to most people. It can be a wake-up call on all sorts of self-destructive behaviour. Even a brief spell without access to cigarettes could be the spur many need to take themselves in check.

But even if it has little practical effect on the addicted, the smoking ban to come into force a week from tomorrow will be good for appearances. A public hospital should reinforce healthy messages in every way it can. All staff, not just health professionals, should be expected to reflect a culture of health. Patients and visitors should be infected by that culture the moment they step inside the building. They should sense disapproval of poor dietary habits and other behaviour that has left them in bad shape.

Unfortunately, that has not been the prevailing culture of the health services. The professionals rather too readily buy into the idea that poor health is to be blamed on society rather than the individual. It is an ethos that lets the practitioners be privately compassionate and publicly tough, a satisfying attitude for them on both counts. But it is probably not in the best interests of patients to be told their unhealthy habits can be blamed on forces, usually commercial, that they are supposedly powerless to resist.

And it is certainly not true. Most consumers have no difficulty weighing up the conflicting messages of commercial producers and public health campaigners. And when it comes to smoking, there is no contest. Even smokers know their habit is likely to kill them. For different reasons, few of which make much sense to others, some still choose to smoke. They have that right, but not in or around hospitals and clinics which the taxpayer provides. When they come for help, they must leave unhealthy habits at home.