The 274 people who think smokers with lung cancer deserve to wait for treatment must learn humanity

IHAVE been wondering about something all week. Have any of the 274 people who said that smokers suffering from lung cancer should be put at the back of the queue for treatment ever watched someone die from the disease?

Have they ever watched a loved one slow to a halt on a normal, winter afternoon walk, having to pause for a while until their breathing rights itself? Have they ever lain awake at night, listening to them cough, wondering where all this was heading and trying to block out what they know is the answer? Have they ever scrabbled around in a bedside drawer looking for the thermometer at three in the morning to check for the level of fever, and to then balance the equation – go to hospital and cause them further distress, or stay at home and pray that the situation doesn’t deteriorate?

Have they ever, indeed, watched, helpless, as their loved one, all of a sudden and after simply standing up, teeters on the brink of respiratory failure, fighting, for what seems like an eternity, for their next breath, only to finally grasp it, and breathe again – until the next time.

Dreadful

Lung cancer, like all cancers, is a dreadful disease, with some 2,500 people diagnosed in Ireland every year. And yes, nine out of every ten lung cancer deaths are due to smoking.

When the Marie Keating Foundation carried out a recent survey of 1,017 adults they found that 27% of respondents thought that non-smokers with lung cancer should be prioritised for treatment over smokers. That’s 274 human beings who feel that people who, for whatever reason, and usually when they were young, opted for a lifestyle that would potentially damage their health should not be given the best chance of continuing to live. That they should, in fact, be treated as second-class citizens and handed, in all likelihood, a death sentence.

Some years ago, a friend of mine who is now in her mid-seventies was diagnosed with lung cancer. She was lucky because it was operable and 20 years later she is still alive.

‘If only we’d known,’ I remember her saying to me at the time, ‘if only we’d known, back when we were young, just how damaging smoking was. But we didn’t. We thought it was glamorous and before we knew it we were hooked.’

As regular readers of this column will know, my husband Gerry wasn’t as lucky as my friend. Diagnosed with lung cancer in May 2014, he died amid the wonderful care of the staff of the Cedar Ward in St Vincent’s Private Hospital in the early hours of the morning on June 22, 2015. Thirteen months from diagnosis to death. He was 62.

Was he a smoker? Yes, for most of his life. But in the 20 wonderful years that we had together he constantly battled with the drug that is tobacco. He wasn’t carefree about it – he genuinely wanted to stop. He quit cigarettes completely 18 years before he died, swapping to small cigars as an intermediary measure to giving up.

He stopped smoking those cigars countless times, and he hated himself when he couldn’t crack it. And I’d watch, unable to help, as this man who could do anything that he put his mind to struggled to get through the day without nicotine.

And then, three years before he died, he did it. After one-to-one sessions with a smoking cessation expert, Gerry kicked the habit. There was one small hiccup in the early days, and that was it. He was done. And he was so happy. But it was too late. So just how, I wonder, would those Mr & Mrs Perfects – all 274 of them – categorise the ‘smokers’ who should be denied treatment?

Disease

Would they condemn to death someone who stopped smoking 25 years ago, but still succumbed to the disease as a result of their substantial earlier nicotine intake?

Or how about someone like Gerry who saw the ‘error of his ways’, battled for years, and finally stopped two years before being diagnosed?

Or what about all the smokers who are battling every single day – with therapy, hypnotism, nicotine replacement, whatever it takes – to stop. Should they also be herded to the back of the queue, with chemotherapy and/or radiation treatment withheld until the unfortunate nonsmokers with lung cancer have had their treatment first?

Really, you’d have to ask yourself where such a mentality ends. Of course people shouldn’t smoke. There are, naturally, some people who don’t care, who carry on and take the consequences and yes, they are selfish, and yes, our over-worked hospital system will probably have to care for some of them at some stage. That’s humanity for you.

But none of us has the right to play God. For when it comes to healthcare, and within the context of back-of-the-queue-treatment for smokers, where does it stop?

We all know that lifestyle choices play their part when it comes to serious illness. People who consume alcohol put themselves, depending on intake, at various degrees of risk. And obesity, too, brings all kinds of long-term health effects.

Willpower

That shouldn’t mean, however, that when people get ill, we ‘rate’ them in terms of how they have contributed to their own problems. Of course they should be encouraged – and helped – to live a healthier life. But people aren’t the same – some are more prone to addiction than others, some have better willpower, some have more personal or professional motivation than others. When it comes to lung cancer – or any disease – there’s no one-size-fits-all situation.

Think about breast cancer. Every year 2,600 women are diagnosed in Ireland and more than 600 die from the disease. How do they contract breast cancer? While there are known risk factors – genetics, for example, or being on HRT, or being childless – you can’t ignore that alcohol intake also increases the risk.

So here’s a scenario. A traumatised woman with breast cancer arrives at the hospital to discuss her treatment which, she hopes, will start any day.

A list of questions are gone through and all is going well. Then she’s asked if she drinks alcohol.

Yes, she says. Oh well, she’s told, sorry about that, no chemo for you for a while, I’m afraid. You’ll have to wait until we’ve treated all the teetotal women first.

Can you imagine anything more cruel or contrary to what medicine is supposed to be about?

While the Latin phrase primum non nocere (first, do no harm) is not actually part of the medical Hippocratic oath, it is, nonetheless, something that every doctor aspires to.

Medicine is about science. But it’s also about care, compassion, and humanity.

All I can say to those 274 ‘perfect’ people is this: no-one knows what is around the corner. And when bad times, potentially catastrophic times, arrive at your door, the last thing anyone needs is sanctimony and judgment. What they do need, and what we will all need at the end of the day, is care, compassion and understanding.