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Smoking and hospitalisation: harnessing medical ethics and harm reduction
  1. Kimberly Sue1,
  2. Dinah Applewhite2
  1. 1 Harm Reduction Coalition, New York, New York, USA
  2. 2 Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Kimberly Sue, Harm Reduction Coalition, New York NY 10001, USA; sue{at}


As resident physicians practicing Internal Medicine in hospitals within the USA, we are confronted on a daily basis with patients who wish to leave the hospital floor to smoke a cigarette. While many physicians argue that hospitals should do everything in their power to prevent patients from smoking, we argue that a more comprehensive and nuanced approach is needed. In part 1 of this perspective piece, we outline the various forms of smoking bans in hospital settings, applauding the development of indoor smoking bans while questioning the move towards stricter, campus-wide smoking bans. In part 2, we turn to traditional biomedical ethics to guide our approach to the hospitalised patient who smokes. This approach, which is informed by our backgrounds in harm reduction and medical anthropology, takes into account the lived realities of patients and acknowledges the complicated sociohistorical contexts of tobacco use.

  • ethics
  • substance abusers/users of controlled substances
  • philosophy of medicine
  • health care for specific diseases/groups
  • autonomy

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  • Contributors Both authors conceived of, drafted and revised this document in equal collaboration.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Collaborators Dr Applewhite and Dr Sue contributed equally to this paper.

  • Patient consent for publication Not required.