Would You Buy Cigarettes for a Man Suffering from Emphysema? An Ethical Question
If you knew that smoking was killing him would you still give him a packet of cigarettes?
A few months ago I received a message from a stranger that someone I knew, but hadn't seen for a few years, was very ill in hospital with emphysema and was asking to see me. I dropped everything and went to the hospital immediately, as I knew it was important, or he wouldn't have sent me this message.
Cigarettes in a dirty ashtray
I was completely shocked by what I saw:
I wasn't even sure if it was him at first. He was lying in bed, slumped over with his eyes closed, gasping for breath. He had a hospital nightshirt on, and it had slipped to one side so that his shoulder was hanging out, and it was just like looking at a skeleton. He had lost all his muscle, and his arms were about as thin as a broomstick. He had an air tube up his nose, needles in his arms and a urine bag on one side of the bed. He'd lost most of his teeth, and white spittle was drooling out of his mouth.
After we had talked for a few minutes, he begged me to go out and buy him some cigarettes.
Health Warnings on English Cigarette Packets
My choice was painful - whether to refuse a dying man his wish to leave this world with a fag in his hand, or whether to give him what he wanted
It wasn't even as though it would make him happy - nothing could do that. It would just ease his pain for a few minutes and feed that insatiable craving.
I pointed out that he couldn't smoke in hospital, and that we should wait till he went home. He became insistent, agitated and voluble, and, like a small child, kept saying, shouting,even, "I want it now, I want it now - just get it!".
It was pitiful seeing this desparately ill man begging for the very thing which had caused his illness.
I felt guilty refusing him. He became more clamorous and demanding, whilst still accepting that he couldn't smoke till he got home - he couldn't even get out of bed, so smoking in the toilet was not an option. Eventually, he made such a fuss that I did go out and buy some cigarettes. Then he begged someone in the next bed for a lighter, and once he had all his paraphernalia, he quietened down, and did in fact wait until he went home two days later.
Once there, he only managed to have one or two, because someone confiscated his lighter so that he wouldn't fall asleep smoking and set fire to his bed, which was a distinct possibility. The thought did cross my mind that that might turn out to be a blessing in disguise in his situation,
And I still had that feeling of guilt, because I had colluded in his harmful behaviour.
What would you have done?
Comforters: A cigarette pattern - isn't that pretty? Yes - pretty lethal!
The issue really is whether, if you are that close to death, you might as well have a little bit of what you fancy to ease your suffering
There was some talk, in my presence, with the doctor who was suggesting a procedure putting a tube in his chest to help his breathing, and he was told he could have it done the following day, but that there was only a 60% chance of success, which wasn't good odds. He was left to think about it, and was later told that the general opinion was that it was not worth the risk, and one doctor even said that as they could not do anything to help him, he might as well go home and smoke.
He could have said smoke himself to death. But that was left unsaid.
Is "tough love" too harsh to inflict on a dying man?
If he is bedridden and immobilised, would you go shopping for him if he begs and pleads?
Post Script: Sadly, my Friend Died on 25th March, 2012
There was nothing more the doctors could do for him to help his condition. It is customary for the medical team or a doctor at hospital to discuss treatment with the next-of-kin and the patient, if able to take decisions. They explained why the only course left was palliative care, as the bodily functions were gradually closing down. No more food as the body didn't need it, and not even any water except to moisten his mouth, as he wouldn't be thirsty. And upping the administration of morphine, to ease the pain.
As it transpired, I was the last person to buy him a packet of roll-up cigarettes. And in retropect, I'm glad I did.