Do patient's have the right to smoke even if family doesn't want them to?

SuesquatchRN, BSN, RN · Dec 9, 2008

If the patient is competent and the facility allows it then sure - why not. A patient has every right in the world to smoke. Although I do agree with the notion that if a petient is well enough to smoke, they are well enough to go home (barring LTC residency, of course).
I can remember when my own grandmother was dying of lung ca with mets. My aunt got very angry with me (a nursing student at the time) for allowing her to have a cigarette. I explained to my aunt that I had shut her oxygen off, I sat right next to her and that she only took 3 or 4 drags off of it before telling me that she was finished with it. I mean the woman had been smoking for 66 years at that point, was on hospice with a DNR. One final cigarette could hardly her her at that point.

That doesn't jibe with "they're well enough to go home."

It's a strong addiction.

:)

NurseyBaby'05, BSN, RN · Dec 9, 2008

when patient is first admitted and if they smoke, they must be evaluated by social worker or nurse to make sure they have dextricity to be able to smoke alone, and if they are not, then staff must accompany patient at all times. i had patients who burned their hand or leg from smoking alone and that is a liability to the facilitiy. if patient is a heavy smoker, they usually have scheduled times to go out and smoke with staff. patients who are alert and oriented can make decision to smoke or not but there are lot of patients in nursing home setting with dementia and family usually make decisions for the resident, and family must bring cigaretts for the residents because staff wont buy them for the resident to smoke.

my question with this is: does the staff have the right to refuse to accompany the pt. out to smoke or does that constitute a violation of the pt's rights? i definitely believe the pt has a right to smoke, but not at someone else's expense.

Flare, ASN, BSN · Dec 9, 2008

That doesn't jibe with "they're well enough to go home."
It's a strong addiction.
:)

I understand that - but we'll usually get a nicotine patch for them if they need one. I am talking about the patients that sneak cigs in the patient bathrooms even after being offered a patch. Or the patient that wanders off the floor and comes back 20 minutes later reeking of smoke but won't get up to do physical therapy.

Virgo_RN, BSN, RN · Dec 9, 2008

LTC residents are at home. That's why they call them "residents". Smoking is legal, and people over the age of 18 have the right to smoke if they wish. It seems to me that the facility has an obligation to provide a safe smoking patio/area for its residents that wish to smoke. On the other hand, if the facility is a nonsmoking facility, then it would behoove potential residents who smoke to refrain from selecting that facility. The resident in question may or may not be legally competent to make their own decisions. I have seen families of perfectly competent, albeit frail elderly, individuals throw their weight around and basically take over decision making for that person without any legal authority behind it.

In this instance, it sounds like the family members direct care for this resident, who is, whether by their own choice or their family's, in a nonsmoking facility. This means that they may not necessarily have the "right" to smoke, since they may be too frail to go all the way down the driveway, and thus, I am assuming, off the LTC premises.

Ethically, I do disagree with this, but realistically, it's not something I'd be rocking the boat over as a nursing student. As a nurse caring for this resident, if the resident was asking to smoke on a regular basis, and being told no was causing significant emotional distress and disruption, then the care plan would need to be reevaluated, including the appropriateness of a nonsmoking facility for that resident.

txspadequeenRN, BSN, RN · Dec 9, 2008

first thing it is a privilege to smoke not a right. if you come into my facility and you are evaluated and you are not safe to smoke then guess what you must be accompanied to the smoke area. we have smoke times and you must comply with those times or you lose the privilege. i have known a patient to die because he was not properly supervised from getting himself caught on fire..its not pretty.

another thing most patients in ltc have mpoa's or guardians; if this is the case and they do not want the patient to smoke for whatever reason..the patient does not smoke.

SuesquatchRN, BSN, RN · Dec 9, 2008

I understand that - but we'll usually get a nicotine patch for them if they need one. I am talking about the patients that sneak cigs in the patient bathrooms even after being offered a patch. Or the patient that wanders off the floor and comes back 20 minutes later reeking of smoke but won't get up to do physical therapy.

Oh, the PITA's.

bagladyrn, RN · Dec 9, 2008

I agree with the other posters that as a student you should not challenge this - though it is something to think through for your future practice. Might make for a good debate for one of your classes on patient rights.

However, as a smoker I am issuing this warning to all the young nurses out there - if you take away my right to smoke when I get old and end up in the nursing home, I'll take up chewing! - and I'll spit! (Just practicing my feisty attitude for future use....)

DA314 · Dec 9, 2008

Just out of curiosity - did the resident have alzheimers/dementia? If they are no longer lucid enough to make their own decisions, family probably has power of atty., and therefore would be allowed to decide if he can smoke or not. Just a thought.

SharonH, RN · Dec 9, 2008

Autonomy is a basic right and it does not end when someone is elderly or in a LTC facility. As healthcare providers, we are often guilty of deferring to family members regarding the care of the elderly because we are so afraid of litigation. It's a crying shame.

ShayRN · Dec 9, 2008

As an ex-smoker I see both sides of the "but I really want one vrs it really stinks" debate. I love my best friend of 25+ years, but do not go to her home because I come out with a headache every time. That being said, I feel very strongly that if a person has smoked for 60 years what right does their child have to say they can no longer smoke? I would assume if there is a DPOA in affect the person is demented or else the DPOA would not matter, the person would have control of their own decisions. The whole idea behind a DPOA is that you make the choice when you are of sound mind incase one day you are not.

So, yes, I do believe a person has a right to smoke if they want to smoke. I also believe that they have the right to aggresive pain managment, but families generally stand in the way of that as well.

Antikigirl, ASN, RN · Dec 9, 2008

A patient has the rights to many things...smoking included! HOWEVER, that does not give the patient full run of employees to take them out or help with this endevor! I mean, would you take that diabetic patient with high blood pressure and cholesterol issues to a bakery to get her sugar/cholesterol fix??? No, that is inappropriate and against our objectives...so there is a line!

The administration of the facility must become involved and a care plan with family must be made for the smoking to happen and how...OR, a plan to stop the patient from smoking, and what to do if they were to leave their rooms/facility grounds/etc to have one! All plans must be documented and the patients rights observed! That way liablity is covered and if the patient was to sneek off and get injured, a plan was in place and the patient didn't observe it...therefore not a liablity of the facility!

As far as any healthcare staff taking someone out to smoke...I say no way!

hypocaffeinemia, BSN, RN · Dec 9, 2008

Hey everyone,
I am finishing up my clinical rotations this week at an LTC and I had a patient that wanted to go out for a cig...the facility was no smoking and I would have to take her out to the end of the parking lot down this paved trail where there is a bench and she could smoke there. When I asked the NM if it was okay she had to go through her chart to see if there was an approval for the family. I am just wondering what if a patient wants to smoke even if the family does not want them to? Do they have a "right" to smoke even though they know all the risks, etc. and know they need to be supervised and brought off the facility property? I know that many hospitals and LTCs have smoke-free grounds, but I just thought it was unusual that a patient needs permission from the family to smoke..don't have the right to as long as staff have time to take them to the designated area?
Thank you so much for your input.

The patient has the right to smoke under the principle of autonomy.

The patient doesn't have the right to expect LTC to enable their right, however.