Should Smokers and the Obese be Denied Coronary Artery Bypass Surgery – No

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The question of whether or not smokers and the obese should be arbitrarily denied coronary artery bypass graft surgery (CABG) must be answered as “no.” I will defend this opinion by first assuming that access to health care is a fundamental right.

By definition, a fundamental right is assumed to be “inalienable and undeniable” unless revoked by due process of law. Since being a smoker or being obese is not a criminal offense, it would seem that arbitrary imposition of limited treatment options for either condition would run a very strong risk of becoming a denial of the constitutional guarantee of equality and “due process.” A hypothetical example will serve to illustrate this point.

Suppose a prominent minister and lifelong advocate of social justice were to meet some future criteria of obesity. If this well-liked and respected public figure were to require CABG, would it be justifiable to make an exception “just this one time” on the basis of his past and potential future accomplishments?

If the answer to the above is “yes,” then the regulation excluding other obese individuals becomes a hypocritical mockery of itself. More ominously, could an exemption be seen as a tacit message that certain past or future behaviors are “good” because exemptions to existing regulations may be granted as “rewards” to those that meet some other criteria. Nor can the “slippery slope” counterargument be invoked because the policy of denying to one what is made available to another is a de facto statement that one group, by virtue of its greater access to care, is now recognized as being “better” than another otherwise identical group.

Many will argue that restricting the availability of CABG to non-smokers and non non-obese would be justifiable because such restrictions would “benefit society” as a whole at the expense of only a relative handful of individuals. This argument presupposes that both conditions are the result of voluntary action on the part of the individual and are thus “self-inflicted.”

Would those with genetic disorders of metabolism also be excluded? Is it ethical to specifically exclude someone who has no real control over their weight, such as those with Stein-Leventhal or metabolic syndromes? Since there is a genetic component to addiction in general, is it ethical to punish these individuals as well? If addiction is taken to mean a chronic neurophysiologic and behavioral disorder that is characterized by an irrational obsessive, compulsive, or excessive psychological and/or physical dependence,’ then it follows that nicotine dependence is also a disease and a disability. Since existing federal law prohibits discrimination against those with physical or psychological disability …

There are, of course, many other arguments against this position that have been posted here. In the interest of editorial brevity the interested reader is invited to view these arguments at their leisure.

In summary, I have argued against the position that smokers and the obese should be denied potentially life-saving access to CABG is neither legally nor ethically justifiable and must therefore be rejected.

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