The National Institute for Health and Care Excellence is advocating that the NHS stops pussy footing around the issue and implements the ban immediately. This view is based on supposedly irrefutable evidence on the dangers of direct and second-hand smoke.
I disagree, however, for a number of reasons. I know that smoking can cause disease and premature death, but I still maintain that people have a right to smoke even if it has a negative effect on their health. As for second-hand smoke, the evidence is weak, based mainly on computer projections gleaned from dubious statistics, and relative risk ratios that mean little but sound terrible when described as inhaling ‘cocktails of toxic chemicals’.
I’m old-fashioned enough to believe in civil liberties and patient choice – and that includes the right to make wrong decisions. But public health bodies hold the polar opposite view, and have almost become lifestyle regulators that expect people to agree only with what they advocate.
The picture often painted is of a pitiful mass of people – patients, staff and visitors – squashed into smoking shelters (if they’re lucky) or obstructing doorways, forcing people to pass through clouds of smoke just to get inside buildings.
But if smokers are treated like stinking, social lepers and pariahs, what else can one expect? Smoking rooms, equipped with sophisticated filtration technology and extractor fans, could be made available but aren’t. Their provision would be construed as actively condoning and legitimising smoking. And nobody in the NHS wants to be accused of that, do they?
Instead, support to make healthy choices is being offered in the form of smoking cessation initiatives. These join the variety of support strategies that have been developed, covering areas such as exercise, obesity, drugs, alcohol and parenting. This presupposes that people are not independent enough to cope and need professional support to sort them out. This is not a progressive trend – it is actively undermining people’s autonomy.
It’s a shame that it has come to this: that smokers are stigmatised, intolerance is promoted and real choice denied. And, worst of all, it pits smokers and non-smokers at each other’s throats instead of enabling them to work out their own compromises and solutions.
Author Bio: Bríd Hehir is a fundraising manager for Do Good Charity which sponsors nurse training and education in Africa. She worked in the NHS until 2011: – as a nurse, midwife and specialist heath visitor and latterly a senior manager. She is a regular contributor to spiked and is a Battle of Ideas Committee member.

First published here Nov 13

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