Smoking and Allocation of Health Care Resources

In light of the finite nature of health care resources, it has been argued that physicians should prioritize the treatment of nonsmoking patients over patients who smoke.7 However, this argument—that it is preferable to devote finite health care resources to treating patients who do not choose to engage in risk-taking and self-destructive behaviors—is difficult to sustain. Most patients engage in some behaviors that contribute to poor health. A physician who refuses care to smokers on this basis might, by logical extension, be compelled to refuse to treat patients who have other risky habits, such as consuming fatty foods, alcohol, or excessive sugar or failing to exercise.8 Ultimately, these judgments about risk-taking behaviors are not supported by morally or practically relevant distinctions.9,10 Although physicians are expected to be good stewards of scarce medical resources,11 allocation decisions should be made on the basis of the costs, benefits, effectiveness, and possible futility of treatments, not on assignment of blame. One area to which it is inarguably important to devote health care resources is smoking cessation. Promoting a tobacco-free lifestyle is essential to preventing the need for costly cancer treatments. In addition, as the number of survivors of cancer continues to increase, it is important to stress that smoking cessation is critical to maintaining good health and lowering the risk of recurrences and secondary cancers. Although surveys show most oncologists discuss smoking cessation with their patients, physicians may not be aware that counseling patients about smoking cessation is reimbursable under Medicare.6