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Here in Canada healthcare is free, lately though a few 'family doctors' have been turning back smoking patients saying they won't see them as loing as they're smoking. If they quit, great, if not, adios. They are tired of treating patients and spending taxpayers dollars on people who make no effort to help their condition. One example was that of a person with chronic bronchitis(sp?).

Now the question is whether this should be an official stand not only here in Canada but in other nations and if this principle should apply to the obese, alcoholics, etc.

Here's the contraversial article from Canada's well known Maclean's Magazine.

Click here.

This is human rights violation!

I'm sure if we have private health care in this country this wouldn't be the case. This is the problem with our health care system, since it's free, doctors and most of all the taxpayers are concerned that "some" people are taking "advantage" of the system. It's easy to deny access to smokers, alcoholics and the obese, since most of the them are poor, on welfare and even minorities. Rich patients who are in the same boat can easily go south of the border for treatment.

I do understand the point that the doctors are trying to make about no amount of cure can help a person who doesn't help himself. My point is, that is his/her life, you have no right to control it. You can't play God on people's lives just because he can't quit. Psychologically, if you are sick and depressed it's hard to quit. To me, the doctors are trying to say, you are wasting your life anyways, why do I have to help you. Of course, you have to help them, it's your profession. Now, what about those people who go in to the doctor's office every month for a sore throat or a light cough or some imaginary ailment they conjured up, don't they put a dent on the doctor's time and money to be spent on people who are actually needing treatment.

I think this article would just push some people to back up a two tier health care system. I know it's kinda' extreme but this is bound to happen.

Its already happened in England and I support it. There they made it so that they would no longer operate (I believe they were referring to hip replacements) on patients with an over-30 body mass index. They have to lose it. I know someone who is rather large and he's always talking about going on diets but never does. If he had to go for an operation and they told him they couldn't operate until he lost 50 pounds I guarantee you he'd lose it in probably 6 months. People usually just don't have the motivation. Also with a law like this in effect it would help encourage a healthier society in the first place.

I'm not talking about controling people's lives. They can do whatever the heck they want with their lives but when they get sick they continue to do things that direct their condition in the oposite direction. My uncle had to go for an operation a few years ago and they told him he had to quit smoking before they could operate. He did. That's not a human rights violation. People who have chronic illnesses in their throats such as bronchitis come in wanting antibiotics but keep smoking. Refusing to help someone who is purposely ruining his own health in that manner is not a human rights violation.

Its not like these doctors won't see people who have smoked, they won't see them while they smoke. This is putting a BIG strain on our health care system. People should have to do their best to help their own condition before they look to taxpayers money. I'm not saying people just shouldn't smoke, smoke as long as you want but when you go for treatment to help a condition you have to quit if not then see ya later.

This is greatly draining our healthcare system, so much money is going into people who don't seem to care about their health that its effecting the people who do. I stand firm that its not a human rights violation. We have our healthcare system in place to help people. That's what its there for. Is it really that much to ask that in ruturn instead of taking advantage of the systemand draining it almost dry that they do a little to help themselves?

Refusing to help someone who is purposely ruining his own health in that manner is not a human rights violation.

It's human rights violation because you are denying healthcare to people. The doctor has duty of care for all patients. A doctor can be sued for not treating a car accident victim on site which caused the victim to die, why can't he be sued for denying access to treatment since the smoker is "still smoking" while on treatment which eventually shortened his life. It's clearly a case of discrimination.

These doctors are just covering their asses on the basis of not getting sued if there are complications after the operation. It's hey, you better quit smoking so you don't come back to me and say your condition got worst and I am sued for malpractice. I bet you, that if our health care system goes private they wouldn't even turn down a single person who is a smoker, alcoholic or obese. It's easy to deny these people because health care is free and just say hey they are a drain in our system.

I think the charter of rights and freedom should read "You would not be discrimated because of your age, race, sexual orientation or religion but unfortunately if you are a smoker, an alcoholic or obese, well our health care system has the right to discriminate you."

How about people who have diabetes and still don't follow their diet, should they be denied of healthcare as well. What about stubborn people who wouldn't drink their medication and their in and out of psychiatric treatment will they be denied, too? How about people who are candidates for heart ailments and still eat burgers and fries, would you deny them, too? Yeah, like I said it's easy to pick on smokers, alcoholics and the obese because they are mostly poor, on welfare, or minorities.

Motivation, huh, easier said than done. Give me stats that say people actually quit if given the motivation that they will add another 20 years to their lives. How many times would a smoker quit before he actually quits for good? He'll be dead by then, since he was denied treatment!

These smokers, alcoholics and obese are taxpayers, too, why deny them the right. Doctors should not play God, take in the patient, if doesn't want to get well, then it's the patient decision not the doctors, not the taxpayers, not the goverment!

Aren't smokers tax payers too?

Very true, Eru. And in a lot of places, smokers pay more taxes than most people do because taxes on cigarettes are intentionally high. Though I'm sure the extra taxes that smokers pay on their cigarettes don't amount to the money spent on their health care.


According to the Hippocratic oath, no person should be denied health care for any reason. It's a doctor's responsibility to treat their patient's symptoms and illnesses to the best of their abilities, no matter what reason the patient has for the symptoms and illnesses.


What if an overweight patient desperately needed surgery, and would die within a couple months if they didn't get it? Would the state prefer to see them die so they could follow their rule on obese patients?

"I'm sorry, Mr. Fox. Can I call you Terry? Ah, good. Well, the thing is, this back pain you've been having is caused by all those marathons you've been running year after year. So basically, it's your own fault. So my professional opinion is for you to fuck off."

"Sgt. St.John-Smythe, you knew when you signed up for duty you might get shot, so quit hollerin' and wait for the blood loss to be such that you pass out. You won't feel anything after that. What's that? You didn't expect to be shot by the Americans? Well, c'mon, everyone expects friendly fire from those bozos."



I hate smoking, but I do it for everyone else.

- I pay tax and duty on cigarettes - a lot of tax if you're in the UK (USD 2,000 / year if I were in the UK.

- I'll die younger, thus helping with the pension crisis

- I'll die younger, thus not requiring home help, and/or freeing up a hospice place for someone else

- I'll die younger, thus probably not requiring a hip replacement / other treatments that old people tend to need when I'm 80

I do this as a service to the rest of you, but for this self-sacrifice I get treated as a social leper.

Shame on all of you!

I think the trouble with the healthcare system is, it's not a "healthcare" system, it's a "sick care" system.

I don't think any doctor should have to treat any patient she doesn't want to. Why should a doctor be any different than anyone else?

My husband has had 2 heart attacks and continues to overwork himself and continues to smoke. I remember very clearly the second heart attack, when he was in such pain that even he, the toughest man in the world, admitted it was about a 15 on a scale of 10, and yet he hasn't quit smoking. I feel like saying to him, "The next godamned time you have chest pains you idiot you can fucking well call 911 yourself."

I won't say it, of course. But I DO wish he'd quit smoking. He doesn't smoke in the house and if I catch him with a smoke I chuck it away whilst cursing and threatening with the above threat about phoning 911 himself. He has actually gone so far, this past week, as to get a prescription for this anti-smoking drug, I think it's Zyban? At any rate he seems to want to quit. But he's one of these high-stress type A's, puts himself under enormous stress, works far too hard, and is, besides, married to me.

While I don't think smokers should be denied health care, or obese people, or drug addicts or alcoholics, I think there might be some benefit to everyone in graduated premiums. Maybe a non-smoking fitness type could pay lower premiums than a fat smoker?

And the various governments should really really think about really really encouraging healthy life habits rather than dealing with things when they've all gone bad?

One teeny little example: a decade or so ago the city of Montreal's public health people offered free fruit and prenatal care for low income women. They were given much good advice, encouraged to be healthy, etc., and the results were wonderful. Instead of the usual low-birth-weight babies usually seen in these women, the infants were of good weight and many of the usual problems associated with poverty, drug use and alcoholism were avoided in this group. There was going to be a very large long-term benefit to the mothers, the babies, and to "society" as a whole. But the program was scrapped because "it cost too much".

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I don't think any doctor should have to treat any patient she doesn't want to. Why should a doctor be any different than anyone else?

I think that would be dangerous. We have doctors not wanting to treat people of certain races or religions...it's too liable to be abused by discrimination.

Lurker wrote:

Refusing to help someone who is purposely ruining his own health in that manner is not a human rights violation.

It's human rights violation because you are denying healthcare to people.

As I heard it they do not "deny" treatment. They tell the people to quit, lose 30 pounds go to AA whatever and come back. The doctor I heard interviewed says all he asks of his patients is a real effort. He goes to university for 8 years and then spends the rest of his working life helping people and then folks come around who ask for help for a certain problem but at the same time are practicing something that is making their problem worse by the day. He even paid for and gave his patients patches and other treatments to help them quit their vice. He said that if they came back in 6 months or so and hadn't been able to stop then he would treat them but he wants his patients to at least give it a hard shot. So treatment isn't denied, its delayed.

I don't think these people should be denied treatment. I say give them 6 months if they want treatment before that then they have to quit their vice, if not well then they have to wait a while. In the meantine all the money that's being sunk into people who worsen their own condition while "trying to get better" could be put into real efforts to help more cureable people.

Our society is full of discrimination, this at least is for a good reason.

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A doctor can be sued for not treating a car accident victim on site which caused the victim to die

Only if he failed to apply the care expected of him as a doctor. As you know, he doesn't have to stop to help the person in the first place, the same issue we're dealing with here.

I do understand that doctors are not directly "denying" them of treatment but it's still discriminaton. What I am trying to say is the minute you tell a person you can't treat him/her because he is a smoker is an outright human rights violation. It's the act itself. Delayed or denied it's the same thing, it's a form of discrimination.

Our society is full of discrimination, this at least is for a good reason.
Wow, I can't believe you actually said that if it's for a good reason, it's okay to discriminate. I think discrimination of any form is bad for any society. Man, I can cite lots of instances where discrimination was applied for the good of society and yet it only got worst.

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Only if he failed to apply the care expected of him as a doctor. As you know, he doesn't have to stop to help the person in the first place, the same issue we're dealing with here.

Bingo! You said it yourself, only if he didn't apply the care expected of him as a doctor. The problem with this is the doctor, wasn't just a passerby on the road, but the actual victim (the smoker) was at his doorstep begging for help. It's part of his duty of care as a professional to treat him.

You didn't even address the fact, they are taxpayers, too, why do we have to delay their access to healthcare?

Well I'm all for the Cigarette companies paying higher taxes that go directly to our healthcare system and if it were up to me I'd raise Cigarette pack prices by at least $1 and funnel that money directly to healthcare. I don't think there is anything wrong with people smoking but if their habbit is going to put a strain on my money then they should have to compensate, its only fair.

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Our society is full of discrimination, this at least is for a good reason.

I didn't say discrimination is good if its for a good reason. I'm stating the sad truth that there's discrimination everywhere and as long as its going to exist at least we might as well have discrimination that helps the healthcare system, its budget and the patient who subsequently gets better by kicking his/her vice.

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What I am trying to say is the minute you tell a person you can't treat him/her because he is a smoker is an outright human rights violation.

There again I see it a little different. The doctors are not denying treatment to people just because they're "smokers", they're denying it because the problem they're trying to fix has to do with smoking or some other vice. Its literally like having a roll of thread to stitch people up with and there's a few people sitting around stabbing themselves, getting stitched up, stabbing themselves, getting stitched up again and before you know it all the thread is gone and the money needed to treat to woman with breast cancer is gone. I know its not yet to the extreme where we're running completely out of money in our healthcare system but I believe the stat is somewhere close to 50% of the money is being spent on smokers, obese people, extremely heavy drinkers, and others. Like the doc on the radio said, he wants to help people but why should he keep prescribing antibiotics for some man's throat problem when he smokes two packs a day. Quit, then I'll give you the meds to get better. I don't see that as discrimination. What I see as discrimination is employers firing employees because they smoke. While many employers do so because the smokers cost them an arm and a leg in healthcare (in the States and with company's healthcare plans) you can't tell a person to quit smoking for a non-medical reason.

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I didn't say discrimination is good if its for a good reason. I'm stating the sad truth that there's discrimination everywhere and as long as its going to exist at least we might as well have discrimination that helps the healthcare system, its budget and the patient who subsequently gets better by kicking his/her vice.

Yes, discrimination does exists, it still doesn't mean that it's okay to discriminate just as long it helps society, though.
This is the meaning of Discrimination - it refers to the denial of equal treatment or opportunities to a group of people. Key word here is "equal treatment".

I do understand your analogy, don't get me wrong, what I can't fathom is the fact that we are delaying (instead of denying) access to treatment for people are who also taxpayers. Like I said, quitting is easier said than done.

I have a coworker who gets pneumonia almost every year, and still puffs her cigarette in between the puff she has to take from her inhaler to allow her to continue breathing.

Every year this happens, I tell her she ought to go on those nicotine patches at least until the pneumonia clears up, but she never does.

It's just weird.

It's not weird. Nicotine is addictive. The companies know this and adjust the nicotine content of cigarettes for the optimum addictive response. Addiction is supposed to be difficult to overcome; that's what it does.

My concern about health services picking and choosing who they will serve is that they will make the decisions according to what will serve their own interests rather than the patients. Those decisions will have little to do with public health and a lot to do with cash in pockets. As Liddy pointed out they can start using all sorts of irrational justifications. I would expect sensible health advice from my doctor. What I don't want are life and death judgments made behind closed doors about his or her misperceptions about my life or worth in society. If I don't want it for myself then I don't want it for others either. If we want to lower the distress and death toll from the tobacco industry there are other ways of going about this.

For one thing, I highly doubt that these doctors would deny treatment if they believed in any capacity that the delay of treatment would seriously impair the patient's health.

Yes, smokers are tax payers as well but they don't pay enough taxes to cover the lengthy treatment needed to keep them alive due to problems caused by their vice. And when we talk about costs, its not just the hospital bills when the lung cancer finally sets in, its all the other problems caused by smoking 10, 15 years before the person even gets cancer. Like what TheMary mentioned. I know someone who recently had to buy puffers for her kid, those things cost like $500. That's a LOT of money and because of smoking these people then need puffers regularily. A puffer a month is $6000/year a cost that could be avoided if the doc said "look you're making your condition worse, stop smoking, come back to me in a month and I'll give you the appropiate treatment."

I still won't call this subject flat out discrimination. Are there aspects of discrimination there? Yes. No doubt. But doing this isn't just about the money its about helping the patients.

If a "family doctor" wants to refuse someone I believe that is their right. It's their practice and if they would rather *not* take my money (or the taxpayers' in the case of Canada), more power to them.

They'll just have to deal with Karma. Refusing to help someone when you are fully capable of doing so gets you a lot of 'dark-side points'.

Maybe, instead of jumping into a huge medical ethics quagmire, Canada should increase their taxes on tobacco and put the proceeds aside for smoker's healthcare costs? That seems fair to me. If the can't afford the tax, they'll quit. If they can afford the tax, they're putting money in the bank for their health issues further down the road.

Sorta like a toll road, or gas tax.

I find the idea that a doctor must treat someone even if they don't particularly want to rather disturbing. Doctor's aren't slaves, they shouldn't have to do any job they don't want to do.

But then again, I usually side with the libertarians on this sort of thing so what do I know.

Riverthalos wrote:

If the can't afford the tax, they'll quit.

No they won't. They'll go without something else...even food. I know people who are quite poor but still buy their cigarrettes. They cut back on other things.

Think about drug addicts. Often times they completely ruin themselves. They can't afford the drugs but does that stop them?

I don't smoke, but I'll fight for others' right to smoke and be treated equally as long as it's not infringing on someone else's health. I agree with non-smoking sections and making most public places non-smoking, but I do not agree with denying smokers medical treatment because that is discrimination and that will only lead to other people being denied health care.

In a way, this seems like another sneaky way a government is trying to tell people how to live their lives.