Key result
Denying cardiac surgery to smokers is unethical and risks broader denial of indicated care.
Why the study?
Ethical concerns exist about denying heart surgery to smokers based on failure rates and self-inflicted damage arguments.
Ethical concerns limit denying care to smokers on aggregate failure rates; leaves open need for individualized outcome data.
determine the level of services rather than to ration special services to particular patients, and it would be up to the government to decide the level of services offered to people.Smokers might argue that the revenue generated by their smoking sustains more than just the NHS budget.Secondly, failure rates derived by statistics do not apply to individual people.It is unethical to deny a patient the benefit of any treatment simply to reduce failure rates.Even the authors admit that the success rate of the operation is not spectacular.Probably there is a stronger case to look at the operation itself than at the imperfect people who have it.The third argument is that the damage caused by smoking is self inflicted.If we extend that argu- ment we might be tempted to deny services to people who do not adhere to a "healthy" lifestyle or strict medical advice; we would end up with an NHS treating only saints.
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Sham Lall Mullick (1993) conducted an editorial in Heart surgery in smokers. Denying heart surgery to smokers was evaluated. Denying heart surgery to smokers based on failure rates or self-inflicted damage is argued to be unethical and could lead to a slippery slope of denying care to anyone not adhering to a healthy lifestyle.
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