Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, August 29, 1993 TAG: 9308290103
SECTION: NATIONAL/INTERNATIONAL PAGE: A1 EDITION: METRO
SOURCE: Los Angeles Times
DATELINE: LONDON LENGTH: Medium
The controversy centers on the refusal by doctors in several British cities to perform heart bypass surgery on heavy smokers unless they agree to quit smoking. The bypass procedure is medically perilous, time-consuming and extremely costly for the health agency, which covers the cost of the operation for qualified patients.
The argument over the propriety of the surgery for heavy smokers erupted this month when Harry Elphick, 47, who sought a bypass in Manchester, was refused by a hospital cardiologist, Dr. Colin Bray, unless Elphick agreed to stop smoking.
Elphick had been referred to Bray for assessment after a February heart attack. Elphick was ordered to kick his 25-cigarette-a-day habit before receiving definitive tests for a bypass. He agreed, though he complained, "Why should doctors dictate to me how I should live my life?" He died Aug. 13, a week before doctors were to examine him at the hospital.
In defense of his judgment, Bray said that most hospitals have a policy of not treating heavy smokers as long as they are stable and not in emergency condition. "Patients who continue to smoke after surgery don't have any survival benefits," he explained. "They don't live any longer than if they haven't had an operation. Those are the hard facts."
That view is in keeping with a stand taken earlier by doctors in other cities, decisions supported by Baroness Cumberlege, the government's junior health minister, who suggested that physicians should "play God" in deciding the priorities for treatment in the health service.
But Elphick's wife and others responded that doctors had no right to "play God" and should treat everyone, regardless of personal lifestyle.
Bray and most of the medical community insisted that the hospital was taking a practical, rather than a moral stand.
"We're not saying that smoking is wicked and sinful," Bray said. "We're simply saying it's bad for people's health in the same way as we would be reluctant to treat the very fat, the people with very bad disease, where the surgical results are poor."
That view was supported by the British Medical Association.
But the British Cardiac Society seemed to differ. Last week it circulated guidelines to its members declaring it could not support a policy that "systematically denies the right of access to treatment for individuals on the basis of a specific risk factor, even if this is self-induced."
by CNB