Health and Medical


Surgery ban on smokers



By Tanya Taylor, medical reporter
The Herald Sun
February 8, 2001


DOCTORS are refusing smokers potentially life-saving surgery until they quit their habit.

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

Alfred Hospital respiratory physician Associate Professor Greg Snell said 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 ongoing 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.