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the indignity of addiction

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By common definition, hospices provide medical, psychological, and spiritual support to terminally ill patients and their loved ones. Such care stresses quality of life—peace, comfort, and dignity. The principal aim is to control pain and other symptoms so the patient can remain as alert and comfortable as possible.  

smoking1Now take a situation where a person comes into hospice with an incurable disease and brings along an addiction to nicotine? In the Western world, smokers have become pariahs and can count on little sympathy. Most hospitals are smoke-free environment, indoors and out. Some hospices provide a smoking room where, as it is the case where I work, where one or two patients may go if they are able. Tobacco products are kept at the nurses’ station and must be picked up one at a time.  

So far so good. Hospices’ accommodation of smoking habits is grounded in a quality-of-life philosophy that informs their practice. Who’d want to deprive someone during their last days of the “peace, comfort, and dignity” their addiction provides. Sudden smoking cessation would exacerbate an already traumatic existence. For some terminally ill people, smoking is one of the few pleasures remaining to them and it can be a coping strategy at a very stressful time.

Still, being allowed to smoke requires that the smoker gets out of bed, shuffles down a hallway in their hospital attire, asks for a cigarette, then carries on, often with the aid of a wheelchair, walker, or cane, to finally sit in an austere little space in full view, to feed the addiction. Hardly dignifying!

Now imagine a patient with a three pack-a-day habit who is unable to obtain the necessary smokes: they may not have the money or simply can’t get out to make their purchases. For some a nicotine patch may be an option, but anyone may refuse such treatment. 

Given all this, how do we (as compassionate care givers and, by extension, as a caring society) provide peace, comfort, and dignity for the dying. What would you do? What if the patient were a dear friend or member of your family?

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7 responses »

  1. It’s a tough one and in a way my mind goes to “it’s not good to generalize” rules never suit everyone and so I wonder if there is some way to have a dialogue with the patient and come up with a solution which may mean compromise on both sides. I know this would be difficult in an institutional setting from a time and ability point of view …. an interesting question” though how to accommodate the needs of the individual in a group setting??? Good training there! You too must have some thoughts on the subject, Peter. I am just thinking about it in my mind, you have been there.

    Reply
  2. this came up yesterday during rounds and caused perplexity around the table. i’ll certainly explore it further. what a dilemma, i thought: would we (or the pharmacy) be doing “the right thing” by providing/purchasing cigarettes for this patient? This would run counter to prevailing medical evidence and public policy … yet it would mean helping to alleviate the person’s suffering.

    There’s more to this, stay tuned.

    Reply
  3. From a nation-wide survey and report published by the House of Commons (UK), September, 2005:

    [We are] keen to highlight the ramifications of denying a lifetime smoker the right to smoke in the last days of their life. Any ban on this would be contrary to the purpose of hospice care—to improve quality of life at the end of life. For some terminally ill people, smoking is one of the few pleasures remaining to them and it can be a coping strategy for patients at what can be a very stressful time.

    The aim of a hospice is to create as home like an environment as possible for terminally ill people. This often includes the right to smoke, as long as it is respectful of other users. Hospices seek to create a balance between freedom of choice and a smokefree environment.

    Some patients who wish to smoke are unable to leave their beds so do not have the choice to leave the building. For this reason the majority of smoking areas are inside the hospice building. In addition … those receiving palliative care, are unlikely to suffer any disadvantages to their health by smoking and behaviour modification will have no affect on the prognosis of their disease.

    … Hospice CEOs expressed concern to us that some people would not access the service if they were unable to smoke.

    full report and survey results at http://www.publications.parliament.uk/pa/cm200506/cmselect/cmhealth/485/485we30.htm

    Reply
  4. Smokes should be provided and if there were some way to allow the people to smoke in their rooms without affecting others, it should happen.

    Reply
  5. And what if someone uses marijuana for pain control?

    Reply

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