Allocation of Health Care to Smokers: Practice and Ethics
Creators: name: University Of California Office Of The President
Publisher: name: University of California Office of the President
publisherIdentifier: https://ror.org/00dmfq477
publisherIdentifierScheme: ROR
Year: 2024

description: Over the past decade, California has instituted a successful public health campaign to reduce the number of active smokers in the state. One result of that campaign has been the increasing stigmatization of the habit of smoking and of smokers themselves. Although the health benefits of a reduction in smoking are clear and non-controversial, there may be unintended social and ethical consequences to health messages which promote a cultural climate in which smoking is not only disapproved of but in which the smoker is held as morally or socially unacceptable. One such possible consequence is the effect that campaigns may have on the distribution of health care dollars and scarce resources such as organ transplants to smokers. Studies show that, often, there are sound medical reasons for the decision to limit care to smokers, but these studies also indicate that the characterization of smokers as somehow morally "less deserving" also plays a role. There is already evidence that implicit, i.e., unacknowledged, rationing to smokers does occur and strong arguments are being made for explicit rationing as well.
 
 
 
 
 
 The difficulty lies in distinguishing appropriate, just ethical allocation of care to smokers that might include some limitations or denials of care from those allocation decisions that are based merely on a bias or prejudice. In addition, difficulty lies in balancing the substantial contributions of anti-smoking campaigns as well as other health promotion/disease prevention programs to the health of the people of the State of California as a whole with the possible detriment to targeted individuals (i.e., those who continue to smoke). A further challenge is in normalizing, at least to some extent, guidelines and policies so that decisions at the bedside or in an HMO clinical case management office are consistent and fair.
 
 
 
 
 
 Addressing these critical ethical and policy dilemmas requires a combination of approaches. We propose first a program of empirical research to document the current status of rationing services to smokers. We need to know the attitudes and actual practices of clinicians, case managers and health care organizations throughout the state. In addition, we need to know the current climate of opinion among members of the general public and individuals who are chronically ill with smoking-related illnesses. However, data, no matter how carefully collected, will not answer the underlying ethical questions. Therefore, we also propose to create an ongoing Ethics Working Group. This group, composed of experts in health economics, health services research, philosophy, bioethics and health promotion, as well as lay representatives, will issue ethical guidelines to assist both health care providers and health care policy makers in determining appropriate care for those who have smoked or are currently smoking, and also to provide general ethical guideposts for caring for groups of individuals who are perceived as having contributed to, or caused, their own diseases.