Patient's rights dilemma

[newgraduategal]

We have a pt. Because of pt condition, the MD advises pt not to smoke.

To make a long story short, the manager pt not to smoke and reminded the charge nurse to make sure that pt is not smoking because of the complication of smoking to health.But a few days later, pt was seen smoking.

Is it really a patient's bill of right to do whatever they want to do while doing something that is risking their health?

[BSNbeauty, BSN, RN]

Since the facility is smoke free, he should not be smoking on campus. It has nothing to do with patients' right. Those are the rules and he needs to follow them. He does have the right to refuse the nicotine patch ( not sure why that is included in the order but whatever). Patients have a right to refuse any medication or treatment at any time. Staff members should not encourage him to smoke on campus. With that said, many patients find a way to get around this and depending on the facility, there is little staff can do about patients that are non-compliant with the smoke free campus rule.

[Kyrshamarks, BSN, RN]

If there is an area designated for smokers...whether on camous or right off, pt's do have the right to smoke. It is not illegal to smoke and he is within his rights under the law to say I am going to smoke, as long as it is where the fire marshall or law allows it. ie. such as not in buildings ect. The hospital cannot kick him out for smoking nor, even if they say no smoking infront of the doors, he could still smoke there push comes to shove. the ball is in the pt's court

[TheCommuter, BSN, RN]

Is it really a patient's bill of right to do whatever they want to do while doing something that is risking their health?

Yes. Patients have the right to slowly kill themselves through smoking against medical advice, drug abuse, compulsive eating, driving recklessly, not following physicians orders, and a whole laundry list of other activities.

It's the patient's body, not mine. The patient only has one body, and they can choose to live a long life or cut it short.

[Anonymous865]

In the USA, an adult patient can do whatever they want as long as it's not illegal. People do not give up their right to autonomy when they enter a healthcare facility.

The facility can decline to accept a patient or transfer the patient. A physician can "fire" a patient. Usually the facility has to find another facility to accept the patient. A physician who fires the patient must give the patient a reasonable amount of time to find another provider and must provide appropriate records to the new provider.

Healthcare providers can not force an adult to do anything. All they can do is recommend, educate, and advise. (and of course document!)

If a diabetic wants to sit in their hospital bed and eat cookies, candy, and cake all day long, they can. They can't force you to provide it, but you can't prevent them from eating something someone else provides.

If a CHF patient wants to consume sodium loaded food and beverages all day, they can. They can't force you to provide a high sodium tray, but you can't prevent them from ordering a pizza and guzzling all the liquids they want.

You can't stop an NPO patient from eating. You can cancel the procedure that required them to be NPO.

[dream'n, BSN, RN]

If the entire facility including the outside surrounding areas are "Smoke-Free", he cannot smoke without leaving the property. Leaving the facility grounds opens a HUGE can of worms, including discharge for AMA. AND he can't be allowed to go AMA without a PICC removal.

[Kyrshamarks, BSN, RN]

Actually he can be allowed to leave AMA without PICC removal. If you held someone against his will to do a procedure it is battery and kidnapping under the law.

[Anonymous865]

A skilled nursing facility cannot involuntarily discharge a resident just for smoking. There are very limited reasons they can discharge the patient w/o the patient's agreement.

See

Your rights in a skilled nursing facility | Medicare.gov

[DisneyNurseGal, BSN, RN]

We can not protect a patient from everything that is bad for them (you have burgers and fried french fries on your patient menu... we do)? Ever seen a diabetic drink soda or eat dessert or candy??

My campus is a smoke free one as well but if I patient wants to smoke, we can not stop them and they can go to the smoking area. If you tell a patient no, they might risk greater harm and try to smoke in the room (it has happened on my floor). We have patients try to smoke in their bathroom, and to add insult to injury they leave their oxygen on or lay it just a couple of feet away. We even had a patient set their blankets on fire trying to hide a lit cigarette. We greatly entourage them not to do it; however; autonomy wins in this case, if you have a patient who has smoked for 40 years, you are not going to get them to quit with just a patch, especially if they already have COPD or Emphysema.

[AJJKRN]

I don't know how other entity's would handle this except for mine but here goes for where I work... Since we have become a smoke free facility no one is to smoke on the grounds which means the patient should have to leave the grounds to smoke which for a patient could be classified as leaving AMA whereas their insurance company then does not have to insure the patient for their hospital stay. The patient has the right to smoke because it is legal but by doing so while in the hospital, against medical advice, the patient does not have the right to potentially increase others premiums or increase the chances of having a poor outcome by lengthening his hospital stay or increasing comorbidities. It sucks to not be able to smoke but too bad so sad! (Not a smoker but I can sympathize if caffeine were to be taken away from me )

That's my story and I'm sticking to it!

[dream'n, BSN, RN]

If this is a smoke-free facility and grounds, he does not by law have the right to smoke on property. People can be told to not smoke or they will be made an AMA. BUT if staff has an area on property to smoke, then well the facility has little leg to stand on I think.

[BSNbeauty, BSN, RN]

This is why some smoke free facilities are a joke. Why have the policy in place if patients and staff are easily able to violate them. I say either remove the smoke free policy or be more strict about enforcing it. My job is "smoke free"" however patients and staff still smoke on campus and no body says a word.