“Right to recommend, wrong to require”- an empirical and philosophical study of the views among physicians and the general public on smoking cessation as a condition for surgery

Abstract

BackgroundIn many countries, there are health care initiatives to make smokers give up smoking in the peri-operative setting. There is empirical evidence that this may improve some, but not all, operative outcomes. However, it may be feared that some support for such policies stems from ethically questionable opinions, such as paternalism or anti-smoker sentiments. This study aimed at investigating the support for a policy of smoking cessation prior to surgery among Swedish physicians and members of the general public, as well as the reasons provided for this.MethodsA random sample of general practitioners and orthopaedic surgeons (n = 795) as well as members of the general public (n = 485) received a mail questionnaire. It contained a vignette case with a smoking 57-year old male farmer with hip osteoarthritis. The patient had been recommended hip replacement therapy, but told that in order to qualify for surgery he needed to give up smoking four weeks prior to and after surgery. The respondents were asked whether making such qualifying demands is acceptable, and asked to rate their agreement with pre-set arguments for and against this policy.ResultsResponse rates were 58.2% among physicians and 53.8% among the general public. Of these, 83.9% and 86.6%, respectively, agreed that surgery should be made conditional upon smoking cessation. Reference to the peri-operative risks associated with smoking was the most common argument given. However, there was also strong support for the argument that such a policy is mandated in order to achieve long term health gains.ConclusionsThere is strong support for a policy of smoking cessation prior to surgery in Sweden. This support is based on considerations of peri-operative risks as well as the general long term risks of smoking. This study indicates that paternalistic attitudes may inform some of the support for peri-operative smoking cessation policies and that at least some respondents seem to favour a “recommendation strategy” vis-à-vis smoking cessation prior to surgery rather than a “requirement strategy”. The normative reasons speak in favour of the “recommendation strategy”.Electronic supplementary materialThe online version of this article (10.1186/s12910-017-0237-2) contains supplementary material, which is available to authorized users.

Addressing Smoking in Musculoskeletal Specialty Care

“…Pri-oritizing cessation efforts before elective surgery is effective preparation for more invasive treatment. Some surgeons or organizations adopt policies with a requirement for cessation intervention prior to discretionary surgery, but this is highly controversial 54,55 . Blanket policies may improve treatment rates; however, some view these requirements as unethical.…”

‘There is no such thing as getting sick justly or unjustly’ – a qualitative study of clinicians’ beliefs on the relevance of personal responsibility as a basis for health prioritisation

“…We found that clinicians would consider the patient's previous history of health-related behaviour to set expectations for future lifestyle to optimise treatment outcomes. Studies of other national public healthcare systems have also identified that attributions of personal responsibility acquire relevance when the aim is optimising the patients' pre-operative health [17,64]. There is a general consensus that prospect of success and medical utility are relevant criteria for the allocation of scarce and costly resources and that differences in patients' expected health gains should figure into priority setting decisions [1].…”

Exploring what is reasonable: uncovering moral reasoning of vascular surgeons in daily practice

“…However, trying to uncover how health care professionals deal with ethical issues is methodologically complex, partly because the term ‘ethical issues’ lacks a clear definition [ 8 – 10 ]. Literature in ethics further displays broad and varied concepts aiming to capture dealing with ethical issues ranging from considerations [ 11 ], perspectives [ 12 , 13 ], views [ 14 , 15 ], conceptions [ 16 ], moral values [ 17 ], ethical reasoning [ 18 , 19 ], justifications [ 20 ], and decision-making [ 21 , 22 ]. Even if there are considerable differences between these concepts, they also point to the intricate methodological problems of trying to capture the dealing with ethical issues in the clinical context of patients and clinicians.…”