Sunday, March 17, 2013

Smoking Policy: Hospice–Palliative Care, Other Patients in Healthcare Facilities (Video 3:33)

Should hospice-palliative care or other patients be exempt from statewide smoking bans?  When I wrote a few years ago about the smoking problems I experienced as a hospice volunteer in nursing homes, I was told that was “a touchy subject.” All the nursing homes where I volunteered had “restricted” indoor smoking areas to accommodate patients and staff who wanted to smoke. I held my breath to avoid second-hand smoke every time I briefly entered a smoking room to get a chair when they were not available in the halls. Smoke, which was both seen in the air and smelled, floated into the halls every time the doors to smoking rooms opened. Whether they smoked or not, everybody’s nostrils were assaulted with sucker punches of first or second-hand smoke.

In the United States, tobacco use remains the single largest preventable cause of disease and premature death. It accounts for billions of dollars in healthcare expenditures and productivity losses. According to Wikipedia, smoking bans in the United States are entirely a product of state and local criminal and occupational safety and health laws. In 1995, California was the first state to enact a statewide smoking ban. More states have followed. Laws often have certain exemptions.

Because hospice-palliative care focuses on meeting patients’ psychological, physical and social needs, a smoke-free policy can be a serious concern. Many feel that terminally ill patients who smoke should be allowed to continue in order to have “quality of life,” particularly when their lives are already so limited. Several of my hospice patients who were only supposed to smoke in restricted areas had oxygen tanks stationed near their beds. Others say smoking has no place in a healthcare institution and that these institutions should all follow statewide legislation.
Should hospice-palliative care or other patients be exempt from statewide smoking bans? What do you think?

This video presents challenges of a smoke-free hospital in England where all hospitals have been designated as smoke-free sites. George Eliot Hospital also offers nicotine replacement therapy as an alternative for helping people, including visitors, quit smoking.

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at booksellers such as Amazon and Barnes and Noble .


  1. Earlier this week I visited a restaurant and was asked whether I wanted "smoking or non-smoking". Such establishments are rare. For the past several years, healthcare institutions have become 100% smoke/tobacco free. I see no reason why hospices should be treated any differently. Just my opinion.

  2. Your restaurant experience reminded me of a similar one I had years ago. The small restaurant had a center aisle of about five feet "separating" the smoking and non-smoking sections. Of course, smoke was floating around everywhere.

    Regarding healthcare institutions, they are not all smoke/tobacco free. Some smokers feel that "person-centered" facilities should meet their needs, too. Several long-term care facilities still have indoor smoking areas for staff as well as designated patients. Some say it is too hard to monitor and control who smokes. Patients can get real or electronic cigarettes from staff, visitors or family caregivers. Some healthcare facilities have patio areas for smokers. Smoking policies still vary in their application from state to state, and facilities get cited for accident hazards.

  3. It seems a little counterproductive to have smoking ares for the patients here. I really think they should be smoke free for the well-being of these people. I mean, they are there to get better after all.

    1. AnonymousJuly 07, 2015

      Many people are in hospice because they are dying. Requiring people who have smoked all their lives to stop during their final days on this planet is just cruel. I personally HATE cigarette smoke, but right now I am looking for a suitable hospice for my brother who is a chain smoker.

    2. I had a hospice patient, a veteran with PTSD. He had severe throat cancer that resulted in his whole neck being bandaged at all times. He loved to smoke. He divided his nursing home days into sessions of cigarette smoking. The hospice organization said he was to be allowed to smoke and not advised to quit at that stage. And he said with a laugh, "I'm going to die anyway, so it might as well be from smoking." Nowadays, he might be eligible for marijuana, too.