One can actually stop smoking without the gum, patches, etc by weaning down just as you would a medication. My facility has free programs for smoking, new mothers, and several others.
A lot of our patient population on my floor, HD, COPD, wounds do not take care of themselves by continuing to smoke, A1Cs through the roof, fail to go to the wound clinic, miss HD appointments and then get admitted d/t their non-compliance. Each admission you see them declining. I believe some of our patients purposely do not take care of themselves so that we can. Some are all alone and like the company of the staff and to be waited on. Some really enjoy the victim mentality to get attention. Some are just flat out lazy and some just think that their body won't give out.
I was not talking about heroin addicts but those patients that come in because they can't urinate, and then we give them IV dilaudid for their chronic back pain. I agree with you that if we quit giving in to unreasonable demands that it would at least cause the patient to have to reflect on their behavior.
Your description of being in the hospital sounds bad with uncomfortable beds, lab draws, etc ( I agree) but for some of the people I take care of I believe it must be better than what they have at home. I have taken care of a few patients that were very attention seeking even to their own detriment. I am not talking about patients with a psych diagnosis although their behavior could warrant one.