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.
Now 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?