We live in a culture where insurance companies are trying to deny health insurance coverage to people who smoke and to people who have a BMI or Body Mass Index of over 30.
And now, I see this topic of: "Should smokers and the obese be denied coronary artery bypas surgery?"
I say to you, now, that to deny health care coverage to people because they smoke or because they are obese is wrong. And to deny them coronary artery bypass surgery when they need it is unethical and immoral.
Coronary artery bypass surgery is a life saving measure and as such should be given to all people who need it regardless of their size or their smoking habits.
In regards to the smokers: There are presently 1.2 billion smokers in the world. They are good people who just happened to get addicted to cigarettes in their youth. They hold down jobs. They contribute to society. They have families who love them...
All of the research that I saw on the net indicated that smoking does not increase the mortality from the coronary artery bypass surgery itself ... meaning that a person who smokes is not any more likely to die from having the surgery than a nonsmoker.
It is clear that those who quit smoking after surgery will live longer and have a better quality of life than those who do not quit smoking after the surgery... According the the research, about half of those who have the surgery will quit smoking after it even without participation in an outpatient program geared toward the goal of smoking cessation. But we do not yet know how many people would have quit smoking if their physicians and nurses helped them get into a smoking cessation program and monitored them to see if they indeed were making progress toward that goal? This does not seem to have been tried.
Perhaps we should be asking another question: "Should insurance companies require participation in smoking cessation programs for all smokers who have coronary artery bypass surgeries?" I would say, "Yes." to this question.
In regards to the the 400 million obese adults and 30-45 million obese children (all with a body mass index of 30 or greater) in the world (2007 stats)... These too are human beings and as such are entitled to receiving life-saving measures such as coronary artery bypass surgeries if they need them...
One study that I read http://www.dukehealth.org/HealthLibrary/News/15 stated that more morbidly obese people (with BMIs of 50 and above) with severe heart disease should be receiving these bypass surgeries as that would increase their survival rates.... Again, the surgery does not seem to increase the rate of mortality in the hospital.
Those who are morbidly obese do surprising welll typically during and after their coronary bypass surgeries. http://ejcts.ctsnetjournals.org/cgi/content/full/22/5/787 but some of them may have some difficulty with infection after the surgery and may need longer hospital stays to deal with these infections. If they were treated with proper control for infections, they would be less likely to need the longer hospital stays. There is no reason to deny them these life saving surgeries. http://meeting.chestjournal.org/cgi/content/abstract/134/4/s44003
I would suggest perhaps the insurance companies should insure that weight loss programs (including diet, exercise, counseling and group support) be provided for those who undergo coronary bypass surgeries especially if they are obese as weight loss would probably reduce the likelihood of the need for more bypass surgeries in the future and would improve the long-term survival rates of all of the individuals who have the surgeries.
To withhold life-saving care from anyone is unethical...
I know that there is a temptation to say... "Look at that smoker... He or she smoked and that is what caused his or her heart problem" or "He or she ate too much... Let them pay the price and go without that surgery." Yet this line of thinking is rather heartless and cruel.
If that person who was suffering chest pain and severe heart problems happened to be your husband, your wife, your own child or your best friend or even yourself, would you be so lacking in compassion? I don't think so. My guess is that you would be demanding that the surgery be given as soon as possible and that you would want to do anything to keep you or that person you love alive.
One who would withhold life saving surgeries from a smoker or from a person who happens to be obese would perhaps also like to withhold them from those who are blind, mentally ill, female, gay, near-sighted, lame, gum chewers, etc... It seems like once people start looking at who to exclude from coverage, they become more likely to find more people to exclude...
And who here on Helium can say that if we do not prevent these obese people and smokers from being excluded from coverage or from the right to have life saving surgeries, such as coronary artery bypasses, you or I or anyone else will not be excluded next?
So to answer the question again in a different way: all people should have equal access to health care and to life-saving surgeries (such as the coronary artery bypass surgery) without exception.