PPAO in the Media
Edmonton Journal
July 7, 2005
Karen Kleiss
Smokes ban violates psychiatric patients' rights:
Advocate backs exemption for mentally ill
EDMONTON - An Ontario advocate for psychiatric patients says Edmonton's coming smoking ban in psychiatric facilities infringes on patients' rights.
Stanley Stylianos, program manager for Ontario's Psychiatric Patient Advocate Office, says psychiatric patients are sometimes in hospital involuntarily and often stay so long the ward effectively becomes home. Outlawing cigarettes deprives them of their right to light up.
"It is not illegal to smoke," he says.
"Nobody is denying the serious health issues related to smoking ... but smoking is a matter of choice, and if people were at home, they could smoke. Patients don't have that option."
The Ontario government agrees. In June, the government passed Bill 164, the Smoke-Free Ontario Act. The legislation included an exemption that requires a controlled smoking area in designated psychiatric facilities.
"We are dealing with a part of the population that is vulnerable and the issues are complex," Stylianos says. Some studies estimate that 80 per cent of psychiatric patients smoke, compared to 22 per cent of the general population.
The man in charge of implementing the stop-smoking program in Edmonton's hospitals says the rights of non-smoking staff and patients trump smokers' rights.
"Those rights stop where it endangers someone else's life," says Dr. Charl Els. A psychiatrist and addictions specialist who also works as the Alberta director of the Physicians for a Smoke Free Canada, Els was hired by Capital Health to design and implement the authority's stop-smoking program.
"We know that designated smoking rooms do not protect against the toxic effects of second-hand smoke," he says.
"Our opinion is that (a ban) does not violate (patient) rights as long as a nicotine replacement is available."
The Capital health authority will give out free stop-smoking aids, such as nicotine gum and patches, to smokers. Psychiatric patients are getting special attention. While Els hopes the psychiatric wards will go smoke free on Oct. 1, 2005 like all other areas, he can get more time if he needs it.
Doctors now know that conventional wisdom about the effects of quitting — that it exacerbates psychotic symptoms, for example — is unfounded. And while psychiatric patients who smoke tend to smoke heavily and be more physically addicted, good treatment programs can help them succeed in quitting.
But some don't want to quit.
One patient who was prevented from smoking at an Ontario Mental Health Centre went to court to argue that the ban amounted to cruel and unusual punishment. He said it was a violation of his constitutional rights and a health treatment imposed without his consent.
Gerald Michael Vaughn asked the judge to stop hospital staff from conducting searches for cigarettes. He said the searches started when patients began smoking secretly after the ban came into effect.
The judge ruled against Vaughn in January 2004, but said the staff at the hospital were unsympathetic to the plight of mental patients forced to quit, and needed to take "extraordinary care" in handling this "vexing problem."
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