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

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Sir: I agree with the sentiments in your leading article 'The fag-end of medical care?' (18 August), which analyses the moral arguments in the tragic case of the late Harry Elphick. As a vascular surgeon in the busiest central London hospital, I can assure you that the doctors, nurses and technicians in our unit do not make moral judgements of the kind implied here.

We recognise heavy smoking as an important cause of stroke, heart attack and limb gangrene, but would never deny urgent or indeed non-urgent treatment to our patients living under a threat to their lives or limbs because of blocked arteries as a result of heavy smoking.

You will be aware that a significant number of our patients are homeless and/or living in poverty. We would never add injury to insult by refusing urgent surgery or other measures to save life or limb. They are informed of the risks of smoking but never turned down for treatment.

I believe I speak for most of my colleagues in the country, and particularly those in busy inner-city hospitals. Priority is given to the most seriously at risk - irrespective of cause.

Yours sincerely,


Consultant Vascular Surgeon

University College Hospital

London, WC1

18 August