Heart surgery could be limited to non-smokers: Financial pressures creating ethical dilemma

MORE hospitals are likely to adopt a formal policy of limiting vital heart surgery to non-smokers because of financial pressures and increased waiting lists, a leading specialist on medical ethics said yesterday.

Commenting on reports that heart surgeons in Manchester and Leicester are turning away smokers who refuse to give up, Dr Richard Nicholson said: 'This is not surprising. In the long term it is the kind of decision that will be made much more frequently as the pressure on society not to waste health-care resources increases.' Similar policies are already in operation informally - at the instigation of a particular surgeon - in hospitals around the country.

Dr Nicholson, editor of the Bulletin of Medical Ethics, said such policies were similar to those adopted in the early days of liver transplants, when alcoholics were excluded. 'It is an interesting ethical question for much wider debate,' he said. 'In one respect it is a crude and utilitarian approach to a problem (of limited resources), but if you believe that everyone has a right to health care and the treatment they need then such policies pose a real dilemma.'

According to newspaper reports, surgeons at Groby Road hospital, Leicester, and heart surgeons at Wythenshawe hospital, Manchester, have turned away smokers who refused to give up and are giving priority to non-smokers on the waiting list.

In a letter to the British Medical Journal, the Manchester surgeons said treating smokers was 'pointless'. They spend longer in hospital, were less likely than smokers to make a full recovery and more likely to need another operation. The Department of Health said that any decision on the most appropriate treatment for a patient was up to the clinician.

A heart by-pass operation costs pounds 15,000 and the demand is growing. The British Cardiac Society warned last week that hundreds of patients were dying while on waiting lists for this operation and other surgery.

Leading article, page 15