Letter: Care for smokers: doctors' priorities, patients' choices

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Sir: Your leading article's assertion that a doctor's task is to heal, not to judge, is far too simple. The cost of modern treatment is such that no National Health Service will ever be able to provide the latest treatment immediately for every individual who might benefit from it, much as we should like to convince ourselves otherwise. Doctors are thus forced to make judgements daily.

These judgements are primarily medical and based broadly on the quality and length of life that any particular intervention is likely to secure. Because they impinge on matters of life and death, however, such judgements are likely to have an unavoidable moral component. This is a responsibility which doctors do not seek, but which is imposed on them by their acquired power.

The time has come to introduce the concept of a self-inflicted ailment. This may be defined as an ailment wholly or partially caused by behaviour which a reasonable lay person may be expected to know is likely to affect health adversely. This concept could be one factor in establishing priorities, but more importantly it would serve to emphasise that the primary responsibility for all our health lies with our parents while we are young and, when we are older, with ourselves.

Yours faithfully,




18 August