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On the 14th
May I was dismayed to read an article in The Express & Star entitled
“Smoking patients may face eviction”.
This
article reported on new policy proposals by The
Dudley Group of Hospitals NHS Trust one of
which stated that patients caught smoking in or around Dudley hospitals
could be thrown off the site under a planned ban due to come into force
next year.
I was
also taken aback by the fact that this proposal (along with the rest of
the Trust’s agenda) was described as “moral” by one of the Trust’s
non-executive directors.
Appalled that such a
proposal should even be considered I wrote an angry letter to the Trust
pointing out that it’s bad
enough visiting hospitals and nursing homes where patients and the
elderly are forced to go outside with their drips and infirmities to
smoke, but the Trust’s intention to discharge smoking patients was
extreme and at best could only be described as being “profoundly sick”
and, moreover, it would run contrary to the Hippocratic Oath.
Following
on from this letter, I also wrote a letter of complaint to Patricia
Hewitt - the Secretary of State for Health -
to re-express my concerns and stating too, that if patients who smoked
were not to receive medical treatment, then it was only right that they
should pay reduced National Insurance contributions as part of these
contributions go to pay for people’s health care.
Eventually, I received
a letter back from Department of Health (dated 6th June)
written by a civil servant, which said that my letter raised a number of
interesting points, but that the current smoking legislation proposed by
the government applies to enclosed public spaces and workplaces only,
and that as NHS Trusts did not fall into this category, it was up to
each Trust to decide its own smoking policy as a result of which the
Department of Health was unable to intervene in this matter.
Next and last, I
received a letter from the Trust itself, written by the Chairman –
Alfred Edwards – which said that it was not their intention to
discharge patients caught smoking but that strict measures would be put
in place to attempt to prevent such an event happening in the first
place. Furthermore, the letter continued, it had been noted that I
intended to write to Patricia Hewitt and that the Trust’s approach was
entirely consistent with government intentions on smoking in public
places.
Now, some interesting
points emerge from all this.
To begin with, it is no
secret that the UK government has put forward the idea that patients
caught smoking inside or outside hospitals face being discharged under
new government legislation which will abolish smoking rooms and
encourage a total ban on all hospital grounds. A similar story was
carried by The Independent on Sunday on 22nd May and, in
fact, has been reported by many sources.
It is interesting too,
the contradiction and denial manifesting itself in the Department of
Health’s letter, when it states that it has nothing to do with
formulating smoking policy in NHS Trusts. Add to that Alfred Edwards’
claim that the Trust’s approach was entirely consistent with government
policy and one is left wondering just who is telling the truth. Well I
know that the Trust is, and that the government, having pushed the idea
of treatment being refused to patients who smoke, is now attempting a
Pontius Pilate-like “we wash our hands of the matter”.
Under the
circumstances, most people of reasonable and balanced sensitivities
would maintain that the Department of Health is not only being
hypocritical but irresponsible, for this is a “let us pass the buck
approach” that fools no-one.
Matters go deeper
however, and I mentioned earlier that I had informed the Trust that
failing to treat smoking patients contravened the Hippocratic Oath. I
also presented this point to Patricia Hewitt by selecting two key parts
from the Oath, the first of which states:
“I will follow that
system of regimen which, according to my ability and judgment, I
consider for the benefit of my patients, and abstain from whatever is
deleterious and mischievous”;
and the second:
“With purity and with
holiness I will pass my life and practice my Art”.
There is another part
of the Oath I wish I had also chosen and this part comes right at the
end:
“While I continue to
keep this Oath unviolated, may it be granted to me to enjoy life and the
practice of the art, respected by all men, in all times! But should I
trespass and violate this Oath, may the reverse be my lot!”
What can we make of
this with regard to doctors and clinical establishments who refuse to
treat patients who smoke? Well, the first quote embodies the principle
of doing no harm. This is frequently referred to and, it is clear that
doctors who refuse to treat their patients properly for whatever reason
are doing harm.
The tone of the second
quote is also quite clear for it is a reminder to conduct oneself with
humility and purity of thought.
The third part is a
stern warning to those who would violate the Oath and it is said in
order to safeguard the importance and essence of good conduct.
There is no doubt then,
about how the Hippocratic Oath counsels doctors to behave and those who
would arrogantly and misguidedly refuse to treat their patients properly
are in violation of it and should therefore be struck off. It’s as
simple as that. For, if the founding principles on which the practice of
medicine is built are not adhered to then that practice becomes devalued
and degraded.
The fact then, that the
UK government has decided to encourage NHS Trusts and doctors to use the
threat and terrorism of withholding treatment to patients who smoke is
without question deplorable. There is no excuse for it and those
doctors who choose to go along with this course of action damn
themselves to an even greater degree than the government by contravening
the very oath which they have sworn to live by.
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