The Neiswanger Institute for Bioethics at Loyola University

Psychiatric hospital posts the no smoking sign

NPR's Morning Edition carried a story this week about a psychiatric hospital that's banned patients from smoking. From the story by Alix Spiegel:

[Hospital CEO] Canavan says some of his staff argued that it just wasn't fair to the patients to take their cigarettes away.

"The attitude was people who are mentally ill have so few things in life that are enjoyable to them. They don't have significant relationships, they may not have a home, they don't have meaningful work. If this is something that is pleasurable, why would you even consider taking it away?" Canavan says.

Nevertheless, the hospital reports that the transition has gone smoothly. And the hospital's CEO seems certain they've done a good thing.

Others aren't so sure. Again, from the story:

"At this point in time, we have no confidence that smoking bans are going to serve the best interests of patients, and we can't support them," says Ron Honberg, a spokesman for the National Alliance on Mental Illness. The organization has more than 1,000 affiliates in the United States.

Honberg says his organization supports the idea that mentally ill people, like everyone else, should stop smoking. But, he says, mentally ill people go to psychiatric institutions at their most vulnerable point, and it's just wrong to force them to quit when they're in such crisis.

"We are worried it's going to make people sicker, it's going to make recovery that much more difficult. And there are many people with mental illnesses around the country who similarly articulate those concerns," Honberg says.

Honberg explains that part of the fear is that if institutions go smoke-free, mentally ill people will no longer be open to getting institutional help.

Many, if not most, health facilities have gone smoke-free over the last decade, but in this case it sounds like the hospital is not just telling patients to smoke elsewhere -- it's actually keeping them from smoking. Is the hospital on the right path here? Or has it overstepped? Would we think about this situation differently if the people involved did not have mental illness?

-Greg Dahlmann

comments

It is a tough call. However I saw a report the other day about a psychiatric hospital that had banned smoking, and it went very well. With smoking cessation products used there were few problems. Certainly it improves the physical health of the patient, and the staff avoid the dangers and worries of being exposed to Second Hand Smoke on a constant basis.

One can give a patient nicotine gum or patches or Wellbutrin.

Psychiatric patients can be successfully self medicating with nicotine so there's no percentage in denying them the use of what may be an effective drug.

It may be tempting to ban smoking because doing so reduces the hazard of fire. And there are now rules about preventing workplace exposure to tobacco smoke.

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