Doctors stand by refusal to treat smokers: Soapbox medicine or scientific medicine? Judy Jones reports on a divided profession

DOCTORS at a Manchester hospital were unrepentant last night after revelations about their refusal to treat committed smokers with heart disease provoked anger among MPs, fellow cardiologists and health campaigners.

Colin Bray, the doctor at the centre of the storm, disclosed his cardiology team at Wythenshawe Hospital had not carried out heart by-pass surgery on smokers for 25 years, except in emergencies. Some doctors at hospitals in Leicester, Leeds and Newcastle upon Tyne were operating the same policy, he said.

The row erupted after Harry Elphick, 47, of Moston, Manchester, died on Friday, the day he was due to go into Wythenshawe for heart by-pass tests. He had suffered a heart attack last February only to be refused surgery because of his 30-year habit of smoking 25 cigarettes a day. His widow Pat, 43, said he would be alive today had he been treated immediately after his first heart attack.

'It shouldn't have mattered whether he smoked or not; he should have been given treatment. It is wrong and quite disgusting,' she said.

Dr Bray insisted last night that requiring patients to give up smoking as a pre-condition of surgery - as Mr Elphick eventually did - was in their interests. 'Stopping smoking will do more to reduce the risks than anything else. This is not a moral view - it is simply pragmatic.' Surgery brought no 'survival benefits' to patients who refuse to give up, he said. 'We were not anticipating that he would have died. We do not withhold surgical treatment if appropriate for patients who are in an urgent situation. We didn't have any information from his local physician that he was in that category.'

Dr Bray set out his case on the BBC Radio 4 programme Today, saying doctors were reluctant to operate on anyone - very fat people, for example - where the surgical results were likely to be poor. A Wythenshawe spokeswoman confirmed that the smoking policy was long-standing, adding: 'We think it does operate in other hospitals, too, but they just keep quiet about it.'

The British Medical Association, appeared to give tacit support to the public stand being made by Wythenshawe. 'The possible complications following heart surgery on a heavy smoker - and the risks during surgery - are great . . . An operation may be considered as an option in emergency cases,' it said. Baroness Cumberlege, the Under-Secretary of State for Health, said such matters were for the 'clinical judgement of the doctors concerned'.

Dr Stephen Jenkinson, consultant cardiologist at St Thomas's Hospital, London, criticised the 'God-like, rather patronising' attitude prevailing in Manchester, and said he would never discriminate in the same way. Dr Graham Jackson, consultant cardiologist at Guy's Hospital and editor of the British Journal of Clinical Practice, cited a major 10-year American study published last year showing that the survival rate of smokers undergoing by-pass surgery was 68 per cent, compared with 84 per cent for non-smokers. 'The differences are not of sufficient scale to justify a ban on treating cigarette smokers.

'To argue otherwise is soapbox medicine, not scientific medicine.'

David Blunkett, Labour's health spokesman, said: 'Everyone has a right to access to the NHS, no matter how foolish they have been in their own behaviour, whether that is in smoking or in fooling about in a boxing ring or on a rugby pitch.'

More girls smoking, page 3

Leading article, page 19