BMJ 2015;351:h6288 doi: 10.1136/bmj.

h6288 (Published 25 November 2015)

Page 1 of 1

Letters

LETTERS
SHOULD PSYCHIATRIC HOSPITALS COMPLETELY BAN SMOKING?

A complete smoking ban in psychiatric hospitals is

ethically wrong
Simon Chapman professor of public health
School of Public Health, University of Sydney, NSW 2006, Australia

Because of evidence of harm to others, there is no ethically

sustainable argument that smoking should be allowed in any
public indoor setting.1 2 Evidence that exposure to smoking
outdoors is harmful, except to smokers themselves, is poor.3

An outdoor smoking ban in such circumstances can be ethically

justified only on openly paternalistic grounds: a ban is good for
the health of patients who smoke because it would force them
to quit while there. But this is not a course of action that society
takes with adults in the outside world. When we ban smoking
in various places, it is justified solely on the grounds of reducing
harm to others.
The proposed ban may help some smokers quit and that is a
good thing. But so would incarcerating all smokers on an island
and depriving them of cigarettes. We dont do that not only
because we cant, but because it would be wrong. The ethical
test of a policy is not just that it will work. In societies that
value freedom, we rarely agree to paternalistic policies with the
sole purpose of saving people from harming themselves if they
are not harming others. Seat belts and motorcycle helmets are
trivial erosions of personal freedoms to protect health.

Some think its sensible to remove one of prisoners and

psychiatric patients few remaining freedoms: smoking outdoors.
These people would be horrified if such a policy was extended
to their neighbours. But apparently its OK with prisoners and
patients because they dont deserve to be treated like other
citizens.
Competing interests: None declared.
Full response at: www.bmj.com/content/351/bmj.h5654/rr-9.
1
2
3

Arnott D, Wessely S, Fitzpatrick M. Should psychiatric hospitals completely ban smoking?

BMJ 2015;351:h5654. (4 November.)
Chapman S. Prisoners should be free to smoke outside. Sydney Morning Herald 2013.
http://www.smh.com.au/comment/prisoners-should-be-free-to-smoke-outside-201309302uo4f.html#ixzz3r1XGWoZYF.
Licht AS, Hyland A, Travers MJ, et al. Secondhand smoke exposure levels in outdoor
hospitality venues: a qualitative and quantitative review of the research literature. Tob
Control 22013;22:172-9.

Cite this as: BMJ 2015;351:h6288

BMJ Publishing Group Ltd 2015

simon.chapman@sydney.edu.au
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