Asthma attack followed by call for tough action on doorway smoking, Cumbria

Every so often I despair of public attitudes on smoking, before reminding myself that a few thoughtless comments tacked on the end of a newspaper story does not represent humanity.

A patient's coughing fit was triggered as he entered the Cumberland Hospital via a doorway where people were smoking. Taking half an hour to recover, he considered that smokers should not be in the doorway, which is not an unreasonable point of view.

The only reason people are there is that they have been denied the comfort of a smoking area to sit down in. For some reason this is considered to be in everybody's best interests, including those patients who 'have' to exit the building for a smoke. Public outrage is expressed if anyone who dares to smoke when hospitalised continues to benefit from NHS care.

How simple can this get? The business of whether anyone smokes when s/he is ill is taken by the patient either alone or in consultation with his/her physician. It is not a hospital management decision. The decision of whether someone visiting hospital to visit a patient smokes is not even a clinical decision. Nor is the issue whether staff smoke. This is the only thing that approaches being a management decision, but a blanket ban on smoking during working hours seems to me peculiarly unwise.

It is absolutely none of the business of the general public.

The way to resolve the problem of smoking in doorways is to provide at the very least a comfortable  and robust shelter at the front of the hospital where it is easily reached by everyone including outpatients with mobility problems, and that provides a preferable solution to standing in a cold doorway. Seating and shelter would help. Coffee facilities in a proper room with comfortable seating would be even better. Nobody who is attending a relative they are anxious about wants to be stuck behind the hospital where they cannot be reached. Nobody in a wheelchair or on crutches will want to trail to the back of the hospital either. If you don't want smokers to be seen at the hospital by the world at large, give them a room that they will want to use. Just how difficult is that?

This is how to use 'nudge' properly. Give people a better alternative and they will choose it over an option that inconveniences everybody – or at least most of them will.

Here is some sense from a Czech legal expert.

It is often said that history repeats itself, but only rarely are we invited to look at the preponderant role of dogmatic ideologues in this recurring phenomenon. As always, they insist that the state should re-educate their fellow citizens by imposing their vision of what is “good,” and this is the case with anti-smoking activists, who are now leading the charge of the partisans of “progress.” Over the last few years, they have successfully campaigned for the introduction of increasingly severe anti-smoking legislation in most European countries, and in so doing, they have taken advantage of a widespread phenomenon in Western civilisation: the drift towards a nanny state and the growth of a culture that is hostile to even the slightest risk.

[...]

Experience has shown that social engineering projects that aim to curtail fundamental freedoms often have unexpected results and in most cases prove to be unqualified failures. This is the future that I foresee for the very strict repressive measures that the EU may be about to impose on smokers, who represent more than a third of the population of Europe’s member states. A few years from now, this kind of legislation could make smoking a symbol — and not just for smokers — of resistance to intrusive and paternalist public authorities and the relentless appetite for regulation in the EU, which is an increasing source of exasperation for a growing number of its citizens.

This observer sees any public health goals of the war on tobacco backfiring, reversing all the good that was done by tolerance.

Meanwhile the Third Estate has picked up the story of the ban throughout the buildings and grounds at The State Hospital at Carstairs: Scotland's secure hospital. Reuben points out that inmates/patients at Carstairs should have the dignity of choosing, just like the rest of us are meant to have.