by Magda D. Healey

Created on: July 12, 2009

Let's be a little more specific.
Firstly, I am assuming we mean financial responsibility, if only because most articles on the subject deal with that aspect, and also because other aspects of the "responsibility" in question are both rather woolly and rather obvious. Secondly, I am assuming we mean "responsibility for the health risks of smoking they themselves incur", as the issue of passive smoking is covered by other debates.

The more precise question is thus "Should smokers bear the financial responsibility for the health risks they incur because of cigarette smoking?".

Actually, they already do.

The annual tax and excise revenue from tobacco in the UK is around GBP 10 billion. The cost of running the whole of the NHS (National Health Service, a universal and free health service for residents of the UK) is around GBP 110 billion. It's not easy to estimate the cost of treatment for tobacco related illnesses, but the highest estimates are somewhere in the region of GBP 5 billion: less than 6% of the NHS budget. The tax revenue from tobacco pays for all of that: and another GBP 4 to 5 billion on top.

In addition to that, persistent, heavy smokers die on average about 10 years younger than non smokers, often from heart attacks or fast-killing lung cancer and the net result of that must be a decrease of medical cost in comparison to the longer living non-smokers: we tend to forget that the extra years of life "gained" by non-smokers are at the end of life, often marred by physical disability, dementia and all kinds of non-smoking related degenerative diseases so typical for old age.

Thus, it's pretty clear that, at least in modern, developed, civilised countries with public health systems and high taxes on tobacco, smokers in general do more than pay for the social and medical costs of their habit.

But still one can hear voices that suggest that treatment for smoking-related diseases should be rationed or free treatment denied to smokers.

There are two major reasons why this is not a morally acceptable solution.

The first one is the obvious moral considerations as Hippocratic oath: help should be given to all, not just the ones that are deemed deserving in one way or another. Anything else becomes the proverbial thin end of the wedge.

If we decide to refuse free treatment for injuries that are self-inflicted, we should also refuse it to those who attempt suicide, to those that engage in dangerous sports and other activities, to those that fail to eat five portions

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