Smoking in Care Setting for Older People: Legal and Ethical Issues - Essay Example

? Smoking in care setting for older people: legal and ethical issues Introduction In accordance with the report prepared by the Centres for Disease Control and Prevention (CDC) and the National Association of Chronic Disease Directors, nearly 13 million British smokers are people who are older than 50 years (Draft National Quality Standards, 2007). In the UK there was an essential drop of smokers’ rate after a smoking ban was acclaimed in 2007 (Draft National Quality Standards, 2007). A more scaring fact is that nearly 70% of deaths among older people in America and the UK resulted from smoking (Draft National Quality Standards, 2007). Therefore, social and medical workers direct all their efforts on decreasing level of smoking among elderly people (Gardner, 2002). In the UK only 1 in 10 general healthcare staff disagreed with a smoking ban in health-care centres for elder people (Gardner, 2002). It means that the great interest of medical staff is focused on the decrease of the level of smokers in health care centres (Gardner, 2002). Some elderly people have a long-term “habit” of smoking. Thus once an old person loses a beloved spouse, he may start smoking again even if he gave it up earlier. Smoking can destroy the health of smokers and non-smokers around them. The latter breathe in cigarette smoke. Mass media has propagated a tolerant attitude to smoking for a long time being driven by commercial triggers (Chiva&Stears, 2001). The issue is even more complicated if it refers to elderly smokers in a care setting. Some elderly people suffer from numerous diseases and it is relevant to inform them about health hazards caused by smoking. It is quite clear that smoking is a trigger of cancer, lung diseases and many other illnesses (Chiva&Stears, 2001). Thus, it is relevant to find a solution to this problem from legal and ethical perspectives. Ethical issues There are four basic ethical principles: respect for person, autonomy, beneficence, non-maleficence and justice. Elderly people who undergo treatment in health care settings should be treated in accordance with these ethical principles. For example, a principle of respect for person is reflected if smokers are aware of the fact that their smoking violates health protection of people around them. On the other hand, freedoms of smokers should not be violated (a principle of autonomy works here); public intrusion of non-smoking policy into personal choices of smokers etc. These issues can be complicated by many other considerations: elderly people have a long-term “habit” of smoking. Therefore older people endanger their relatives or people around them and expose people in a care setting to second-hand smoke. A controversial ethical dilemma occurs: whether to ban or not to ban smoking to old person? It is a violation of smoker’s freedom, is not it? First of all, a smoker is a citizen. He should not feel that their freedoms are restricted. Smoking is not an illegal practice. Of course, there is no doubt that good of the public should not be sacrificed in the name of a smoker’s satisfaction. Legal issues If to consider smoking from the perspective of smoking as a personal choice of a smoker, then smoking ban should be considered from legal and ethical perspectives. In accordance with the American Medical Association Code, “Health professionals are under obligation to put the patients first, regardless of economic status or physical condition. Each profession within the health care field has adopted its own code of conduct” (Gardner, 2002).. With regard to an elder patient of health care setting in case he cannot make decisions himself, it is relevant to take control over his mental capacity. In case, “a decision should be made for them, that decision must be made in that person’s best interests. You must also consider whether there is another way of making the decision which might not affect the person’s rights and freedom of action as much (known as the “least restrictive alternative principle” (Mental Capacity Act).Therefore, whether to forbid smoking outside the health care setting, is on behalf of medical personnel decision if a person is unable to decide for him. Such a conclusion the medical staff can make if an elder person behaves like a mentally disable person. A legal regulation on smoking ban was launched in US in 2003. New York bars and restaurants forbade smoking. Therefore, a legal consideration of the issue of smoking in public places was created in the name of public good (Gardner, 2002). The same tendency can be seen in healthcare settings for elderly people. Moreover, smoking in care setting for old people is regulated by Draft National Quality Standards for Residential Care Settings for Older People (August 2007). Regulations of this document are developed in compliance with the Public Health (Tobacco) Acts 2002, 2004. The main principles of these regulations imply that there is a necessity for a “separate designated smoking room” (the Public Health (Tobacco) Acts 2002, PI, section 3). In such a way, a non-smoker would not be endangered to health risks. Moreover, non-smoking regulations in care settings for old people propagate a “continuous supervision of smokers with due regard to “duty of care” as outlined under health and safety legislation”, e.g. the Public Health (Tobacco) Acts, 2002; Draft National Quality Standards for Residential Care Settings for Older People, August 2007. Every residential care setting adopts a “smoking policy.” A better situation is in the UK. There are only 14% of smokers aged 60 or older. Still, because of ban for promotional campaigns of cigarettes and propagation of healthy way of life, there was a significant decrease of death in the result of lung cancer in the UK during the last three decades (Chiva&Stears, 2001). Moreover, the country follows international regulations on smoking in public places and residential areas (such as regulations of the World Health Organization (WHO) on public health, the Framework Convention on Tobacco Control (FCTC) and others) (Carrabine et al, 2000). Currently, “On 28 February 2005, the Framework Convention on Tobacco Control came into force as a result of at least 40 countries becoming State Parties through ratification of this first ever health treaty sponsored by the World Health Organization” (Draft National Quality Standards for Residential Care Settings for Older People, August 2007.). Thus, legal regulations on smoking are globally accepted and approved. Attention of the world’s society to smoking ban underlines that there are no indifferent to the problem of smoking and public attention to the problem of smoking signifies that people want to live longer in a healthier world. Why not to spread this tendency and develop appropriate strategies directed on smoking level decrease among elderly people? It is better to think about good for others at the expense of smokers’ autonomy, because harm for the health of others is huge. There is a great need to develop policies for old people care settings, where it would be ethically valuable to facilitate a process of smoking giving up by old people and not to violate their freedom or their choice to smoke. For example, it is possible to organize public translations of films about smoking harm or to organize special trainings offering easy ways to give up smoking. Moreover, it is necessary to choose the most caring members of medical staff in order to facilitate a process of smoking giving up among elder people. Ethical issues should be covered in the specially-developed plans and self-help materials available for any patient who wants to quit smoking (Bernard, 2000). These materials should propagate utilitarian principles of “doing the greatest” for the sake of the most important issues: the health of smokers and people around them. Bioethical concerns A specific nature of the considered problem requires a specific consideration. Health risks of smokers cannot be hidden behind their “personal choice” to smoke. Governments should control and regulate human behavior, which may be harmful for surrounding people; they should act in compliance with a “precautionary principle”, by which a government may preclude population exposure to a likely hazard even without absolute proof of the hazard propagation” (Beauchamp and Childress 2001, p. 43). This principle may be essential for elder smokers. Thus, nurses in care settings for old people and other medical staff, psychologists and social workers should consult smokers in order to trigger a desire to give up smoking (Draft National Quality Standards for Residential Care Settings for Older People, August 2007). The following data indicate that smoking would lead to nearly 16% of adult deaths in the world by 2030 (Chiva&Stears, 2001). Consequently, it is an ethical obligation of the world’s governments to prevent humanity from deaths caused by smoking. Alternative perspectives on smoking among elderly people On the contrary, there is an alternative consideration about smoking in old people care settings. Smokers are persuaded that smoking ban violates their rights and freedoms, but they hardly realize that health of surrounding people is in danger (Gecker, 2003). “Non-smoking policy in care settings for old people should be developed with regard to the following basic claim: this policy would decrease levels of cancer, asthma, and heart illnesses” (Gecker, 2003). Unfortunately, a desire to smoke is often perceived by elder smokers as an integrative part of their lives. In accordance with some smokers, they smoke for relaxation after an emotional stress or a hard day. Therefore, smoking ban destroys the lifestyles of elder people. To break stability of someone’s life in the name of health of others is an ethical principle violating autonomy for the preference of utilitarian principles. It is better to develop such kind of legal regulation, which will take into account interests not only of non-smokers, but also would be acceptable for smokers. For example, there should be permitted areas to smoke in public places (Graham, 2000). This strategy is an integral part of care settings for elder people “smoking policies”. Conclusion As far as we can see, ethical dilemma of smoking among elderly people in a care setting can be partially solved by legal regulations and internal regulations of the settings. Moreover, on the example of USA and UK it was clearly seen that following international regulations on public health, it is easier to fight against a destructive force of smoking. The most positive result of both non-smoking policies on international level and on local level in the health-care institutions for elderly people has the primary goal: to decrease the level of potential deaths from smoking. Unfortunately, current smoking ban policies are believed to restrict freedoms and rights of elderly smokers in favour of non-smokers. Therefore elder smokers endanger their relatives or people around them in a care setting to second-hand smoke. From utilitarian ethical perspective, smoking ban among elderly people should be considered from another point of view: a bad habit cannot overweigh public good. Moreover, legal regulation on smoking on governmental and care setting level should be developed with regard to the considered ethical issues, where public good prevails over potentially harmful habits of elderly smokers. Works cited 1. Beauchamp, T. and Childress, J., 2001. Principles of Biomedical Ethics. 5th Edn. Oxford: Oxford University Press. 2. Bernard, Miriam, 2000. Promoting Health in Old Age: Critical Issues in Self Health Care. Philadelphia: Open University Press. 3. Draft National Quality Standards for Residential Care Settings for Older People – A Consultation Document, August 2007. Available at: [Accessed April 03, 2011]. 4. Carrabine, Eamonn, Maggy Lee, and Nigel South, 2000. Social Wrongs and Human Rights in Late Modern Britain: Social Exclusion, Crime Control, and Prospects for a Public Criminology. Social Justice 27: (193), p. 12+.. 5. Gardner, K., 2002. Age, Narrative and Migration: The Life Course and Life Histories of Bengali Elders in London. Berg. 6. Graham, Hilary, ed. 2000. Understanding Health Inequalities. New York: Open University Press. 7. Jamrozik, K., 2005. Estimate of deaths attributable to passive smoking among UK adults: database analysis. BMJ 330(7495): p. 812 8. Mental capacity act. [online]. Available at: [Accessed April 03, 2011] 9. Chiva, A. and Stears, D., 2001. Promoting the Health of Older People: The Next Step in Health Generation. Open University Press. 10. Public Health (Tobacco) Act, 2002. [online]. Available at: Read More