by Dave Simmons

Created on: June 19, 2008

Quite frankly, no.

Let's start by defining why anyone would say 'yes'. Firstly, the idea is that smoking is a conscious choice, that smokers are fully aware of the risks, and therefore it's their own fault if they end up ill because of it. Cancer, heart disease, emphysema, and so on. Therefore, they should have to foot their own medical bills, be it either because their HMO refuses to, or the nationalised health service in more civilized countries forces them to be treated privately.

I'm not going to touch on whether smoking is a choice or an addiction in this article. Everyone has their own opinion, and really, it's academic. No-one starts addicted to anything, it's a conscious choice to become so. No-one actually forces you to smoke long enough to gain a chemical addiction to nicotine.

So, why is that such a bad idea?

Firstly, it's a double standard. Why is smoking being singled out here? If someone is an alcoholic, does that mean they should pay for their treatment? What about obese people? Is taking that fourth helping of pudding a conscious neglect of their health, and thus they should have to pay? What about firefighters? They deliberate put themselves in harm's way, so they should pay up if they get hurt.

Some people will protest the last one, but then consider this: What about hang-gliding? There may be a moral reason to support firefighters, but what's so ethical about deliberately strapping yourself to a frame covered in canvas and hurling yourself off a cliff? If they break their legs, it's their own damned fault. They knew the risks.

Take it one step further: If a person avoids all of the above, and generally lives illness free, but then has a heart attack, what criteria should we apply? Is he liable to pay if he didn't join up with a gym to make sure his body was in the peak of health? What if he only went once a week instead of three times? Surely he has a duty to optimise his future health. And if he collapses from overexertion at the gym, well again, he knew the risks.

Next point, and people don't like this one, but it does come up: Governments rely on people smoking. It provides a tax which fills their coffers, a tax which is then spend on things like, oh, healthcare. Banning smoking tomorrow would cause a deficit. It also cuts down on expenses later on. Regardless of whether they're treated, smokers die from smoking-related illnesses, often quite young. Young enough that the cost of any national healthcare is greatly offset by the saving in state pensions they would have otherwise been able to claim. A few months of palliative care is far cheaper, on paper, than paying someone a regular stipend for thirty years. It's a brave politician who admits this kind of thinking goes into the budget, but occasionally one does, to much disgust by the public.

Told you you wouldn't like it.

Let's get back on firmer moral ground, here. Anyone remember the Hippocratic Oath? To do no harm? I can't imagine there's a doctor in the world who would condone such a heartless policy as to deny treatment to patients in need, unless they were self-funding. But then, I'm an incredible optimist, and that's even after having worked with a variety of doctors for over ten years who make my teeth itch to be in the same room as them.

This, essentially, is why you'll never see this happen. People might whine and complain that it's taking funds from elsewhere to treat these people, but that's really the sum total of the argument on the 'yes' side.

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