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CANBERRA - Smokers should be refused some types of surgery if they refuse to give up the habit, an Australian doctor says.
Respiratory expert Matthew Peters said denying smokers joint replacement surgery, breast reconstructions and some other types of elective surgery was justified because the operations were more risky and costly when performed on smokers.
"In healthcare systems with finite resources, preferring non-smokers over smokers for a limited number of procedures will deliver greater clinical benefit to individuals and the community," Associate Professor Peters writes in the latest issue of the prestigious British Medical Journal.
"To fail to implement such a clinical judgment would be to sacrifice sensible clinical judgment for the sake of a non-discriminatory principle."
Prof Peters, from the Concord Repatriation General Hospital in Sydney, said smoking ahead of surgery increased cardiac and pulmonary complications, impaired tissue healing, and was associated with infection rates up to six times higher than in non-smokers.
Joint replacements for smokers cost 38 per cent more because of longer hospital stays and higher risk of a second operation being required, he said.
Five non-smokers could undergo surgery for the same cost and bed use as four smokers, and the non-smokers would have a better chance of success.
"Therefore, so long as everything is done to help patients stop smoking, it is both responsible and ethical to implement a policy that those unwilling or unable to stop should have low priority for, or be excluded from, certain elective surgical procedures," he said.
Prof Peters' view has attracted criticism from a US academic, who writes in the same journal that depriving smokers of surgery is not just wrong, but mean.
"It is shameful for doctors to be willing to treat everybody but smokers in a society that is supposed to be pluralistic and tolerant," Professor Leonard Glantz from the Boston University School of Public Health said.
Professor Glantz said smoking was known to be addictive, and although smokers were at a greater risk of complication, most who underwent surgery had no problems.
It was unacceptable discrimination, he said, by doctors who routinely treated enemy troops, terrorists and murderers.
- AAP
