Abstract
The question whether rights to health care should be altered by smoking behaviour involves wideranging implications for all who indulge in hazardous behaviours, and involves complex economic utilitarian arguments. This paper examines current debate in the UK and suggest the major significance of the controversy has been ignored. That this discussion exists at all implies increasing division over the scope and purpose of a nationalised health service, bestowing health rights on all. When individuals bear the cost of their own health care, they appear to take responsibility for health implications of personal behaviour, but when the state bears the cost, moral obligations of the community and its doctors to care for those who do not value health are called into question. The debate has far-reaching implications as ethical problems of smokers' rights to health care are common to situations where health as a value comes into conflict with other values, such as pleasure or wealth.
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Selected References
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- Boughton B. J. Compulsory health and safety in a free society. J Med Ethics. 1984 Dec;10(4):186–190. doi: 10.1136/jme.10.4.186. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dean M. Self-inflicted rationing. Lancet. 1993 Jun 12;341(8859):1525–1525. doi: 10.1016/0140-6736(93)90648-z. [DOI] [PubMed] [Google Scholar]
- Garfield J. Should smokers be offered coronary bypass surgery? Let the health authority take the responsibility. BMJ. 1993 Apr 17;306(6884):1050–1050. doi: 10.1136/bmj.306.6884.1050. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Harris J. Must doctors save their patients? J Med Ethics. 1983 Dec;9(4):211–218. doi: 10.1136/jme.9.4.211. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Khalid M. I. Access to surgery for smokers. Denying treatment is indefensible. BMJ. 1993 May 22;306(6889):1408–1408. doi: 10.1136/bmj.306.6889.1408. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mamode N. Access to heart surgery for smokers. Denying access more costly. BMJ. 1993 May 22;306(6889):1408–1408. doi: 10.1136/bmj.306.6889.1408-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
- McGlade K. J., Bradley T., Murphy G. J., Lundy G. P. Referrals to hospital by general practitioners: a study of compliance and communication. BMJ. 1988 Nov 12;297(6658):1246–1248. doi: 10.1136/bmj.297.6658.1246. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Persaud R. D. What future for ethical medical practice in the new National Health Service? J Med Ethics. 1991 Mar;17(1):10–18. doi: 10.1136/jme.17.1.10. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Powell J. E. Human rights. J Med Ethics. 1977 Dec;3(4):160–162. doi: 10.1136/jme.3.4.160. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sider R. C., Clements C. D. Patients' ethical obligation for their health. J Med Ethics. 1984 Sep;10(3):138–142. doi: 10.1136/jme.10.3.138. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Underwood M. J., Bailey J. S. Coronary bypass surgery should not be offered to smokers. BMJ. 1993 Apr 17;306(6884):1047–1048. doi: 10.1136/bmj.306.6884.1047. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Weale A. Statistical lives and the principle of maximum benefit. J Med Ethics. 1979 Dec;5(4):185–195. doi: 10.1136/jme.5.4.185. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Weinkam J. J., Rosenbaum W., Sterling T. D. Smoking and hospital utilization. Soc Sci Med. 1987;24(11):983–986. doi: 10.1016/0277-9536(87)90292-9. [DOI] [PubMed] [Google Scholar]
- Wikler Daniel I. Persuasion and coercion for health: ethical issues in government efforts to change life-styles. Milbank Mem Fund Q. 1978 Summer;56(3):303–338. [PubMed] [Google Scholar]