I ran across this news story the other day reporting that surgeons at The Alfred Hospital in Melbourne Australia are insisting that smokers quit smoking before undergoing major heart and lung surgery.  A statement from the hospital reads:  “The scarcity of organ availability obliges the Hospital to ensure that the best outcome from the ‘gift of life’ of an organ donation occurs.”  It’s about time, as far as I’m concerned.  As an organ donor, I (my family, actually) would like to see my organs go to somebody who’s going to take care of himself rather than to somebody who just wants a little more time to enjoy his self-destructive lifestyle.  It may sound cold hearted, but that’s just the way it is until organs start growing on trees.

As you might expect, not everybody is happy about this decision.  Opponents of the policy insist that smoking is an addiction that is positively enforced by society, and that denying smokers treatment is akin to refusing to treat an alcoholic or suicide.  That may very well be true, but then alcoholics and drug abusers are often required to undergo rehabilitation, and suicides are required to undergo psychological treatment.  Smokers, on the other hand, although encouraged to quit, cannot be required to undergo any kind of “stop smoking” treatment.  “Patients arbitrarily being denied treatment,” according to one person quoted in the article, “is ethics masquerading as clinical judgments…competent surgeons are not ethicists.”  No, they’re not, but they do have the responsibility to see that scarce organs are put to their best use.  This isn’t a value judgment based on social or economic status, but rather a clinical judgment based on the likelihood of the patient surviving the transplant and recovery, and actually benefiting from the procedure.