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—Mr Sceppa raises an important dilemma in implementation of institutional smoking policies. In hospitals, restrictions are designed to protect the health of the majority of patients, employees, and visitors who do not smoke. They are not intended, as Sceppa implies, to replace smokers' "personal ethic" with one of health promotion or longevity. While this would be a beneficial effect, it is difficult to show that policies change patients' smoking habits. Protection of ill patients from the effects of environmental tobacco smoke is an ethical issue as well as a medical one. Certainly, patients have the right to smoke, with its attendant health risks, but only as long as they don't harm others in the process.To respect a patient's right to choose the health risk of smoking, they would have to be directed somewhere within the hospital. To adequately ventilate smoking accommodations requires a separate air circulation system,
Joseph AM. No-Smoking Policies in Hospitals-Reply. JAMA. 1992;267(24):3287. doi:10.1001/jama.1992.03480240048028