Wednesday 22 May 2013

If it saves only one life... oops.

New Zealand's been pretty gung-ho about banning smoking. Tobacco taxes have been rising pretty sharply; tobacco can't be displayed by retailers and instead has to be kept concealed; the Government's unattainable aspirational goal is a SmokeFree New Zealand by 2025.

As part of this push, New Zealand banned smoking in prisons. And some hospitals have been a bit aggressive in banning smoking not only within the premises but also on the grounds outside of the hospitals. It's pretty easy to argue that folks going to hospital to get well shouldn't be smoking. Hey, maybe that gives them the extra shove they need to quit. Right? Oops.
A mental health patient who killed himself was put off seeking hospital treatment because he was not allowed to smoke onsite, a lawyer leading a judicial review application on smoking in hospitals says.
A smoking ban on hospital grounds including outside psychiatric wards by the Waitemata District Health Board is a breach of human rights, barrister Richard Francois argued at the High Court at Auckland today.
He is calling the proposal "torture" on the hospitals' most vulnerable patients.
"Psychiatric patients are segregated," Francois said in his opening statement.
"They're locked in a room and told they can't smoke cigarettes in a time they're under extreme stress, have been hauled away from family, friends and employment."
He argues that research does not back up the need for psychiatric patients to give up smoking on hospital grounds for their health or the health of others, and is simply a breach of rights which will create a barrier for patients wanting to seek help.
This kind of response shouldn't have been all that surprising.

There is a rather extensive literature on comorbidity of smoking and serious mental illness. Some argue that nicotine can serve as self-medication for those with specific mental illnesses; others say instead that it's a way for those with serious mental illness to impose some structure on their days and is a changeable part of the culture of mental illness. Either way, it's pretty hard to avoid that smoking rates among the mentally ill are much higher than those among the general public. That can provide a pretty decent argument for finding ways of helping those with mental illness to quit smoking. Or, from the other side, you could argue that those with lower life expectancies and who have a harder time enjoying life to start with oughtn't be deprived of those things that they do enjoy.

Either way, banning those placed in psychiatric hospitals from smoking outdoors on hospital grounds seems remarkably punitive. It seems pretty unlikely that enforced cold-turkey treatment while being hospitalised for mental illness is best for anybody.
He [Francois] raised an example of a Hillmorton Hospital patient in Christchurch who used to self-refer himself to the psychiatric ward after attempting suicide.
His mother had said he "quite liked" being there but this changed after a smoking ban came in, Francois said, reading from a Coroner's report.
"He killed himself this time. Smoking was everything to him, it was like the be all and end all of it really."
Wouldn't it have made more sense to have specialised smoking-cessation help for those with mental illness? Pretty sad when smoking is someone's alpha and omega. Even sadder when we get this instead.

Update: just so we're clear, I disagree with the synopsis that I reckon the policy killed the patient. Causality is way too hard to establish to say anything like that. Barriers to entering treatment seem a bad idea; the policy made this kind of incident more likely. And it seems an awfully hard policy to restrict access to pleasurable things to those people who have a harder time experiencing pleasure.


  1. "Or, from the other side, you could argue that those with lower life expectancies and who have a harder time enjoying life to start with oughtn't be deprived of those things that they do enjoy."

    I like what you said there Eric (and I don't smoke, by the way). It bothers me that these allegedly "caring" health professionals seem to neither understand nor care about how much even the smallest things can matter to someone who is in extreme psychological distress, let alone something like smoking that is a really big deal even to those who are not mentally ill, but who are addicted.

    Do these people lack empathy, or just imagination? What kind of people are they, really?

  2. What about going the other way and forcing mental health patients to smoke, as after all its either self medicating, or providing some structure to their day?

    I don't think on the count of one clearly irrational person we should change a policy the benefits the health of many, not to mention those who are being treated. There will always be an outlier to the norm.

    Just like most people stop when the police chase them, others (irrationally) try to flee. Doesn't mean we should stop the police having the ability to pull people over now does it?

  3. Because I oppose compelling people to do ~X, you think I'd support compelling them to do X? It's the compulsion that I don't like!

  4. So why don't we institutionalize all smokers and prevent them from smoking, seeing it's so beneficial for their health? Why stop at psychiatric patients? Why stop at smoking?

  5. And then we wonder why an irritable, distracted, fidgety person is labelled as Mentally Unfit and locked up.
    Do you think its humane for the doctors to judge their patients when they are having withdrawl symptoms? Which is the medical issue, and which is the withdrawal?
    Is this the price they have to pay, to recieve assistance? Saving one life is a small price to pay, by allowing smokers to continue smoking.

  6. The case described had someone avoiding voluntarily committing himself because he didn't want to be under a smoking ban.

    Employers can ban smoking on their premises, but there aren't many who'll prevent you from going outside for one...