Medical Matters/Dr Muiris Houston: With the Republic to become the first country in Europe to ban smoking in the workplace, assuming the Government's proposals become law in January, the State's excellent record in the area of tobacco control is set to continue.
When the recently ratified Framework Convention on Tobacco Control was published by the World Health Organisation it was notable that we had already implemented most of its recommendations.
Being the first with anything is always a challenge. In this case it has meant the international pro- and anti-tobacco lobbies have identified the Republic, in the words of one activist, as the beachhead for Europe. Put crudely, if we manage to implement a workplace ban on smoking the tobacco industry faces significant financial damage across Europe.
We are unique also in having a strong pub culture. This has led to the much publicised campaign by vintners and some hoteliers to have the legislation watered down. Their economic arguments do not withstand comparison with the experience of similar bans in North America and Australia, however.
Most health professionals favour the workplace ban - and not just for selfish reasons to do with a reduced exposure to cigarette smoke in hospitals and clinics. Considerable research evidence shows that a reduction in passive smoking will bring immediate benefits in terms of reduced childhood asthma and adult respiratory problems. In the medium term it will also mean less lung cancer and heart disease, two of the biggest killers in our society.
But, like any sweeping move, the ban is not without potential problems when a holistic, whole-person view is taken. Banning smoking by patients in psychiatric hospitals and hospices is, quite frankly, cruel.
Walk into an acute assessment ward of any psychiatric unit and it will be thick with a blue fog of cigarette smoke. You will be met with people in various states of agitation; some will be pacing up and down, sucking hard on cigarette after cigarette in an attempt to soothe the turmoil of their thoughts and emotions. Others will be chain-smoking and consuming many more cigarettes than they do when they are well. Research suggests that 70 per cent of people with psychiatric problems smoke.
Fast-forward to January and imagine the scene in the same wards. As the proposals now stand, there will be no open smoking in the wards. In some modern units - and, it must be said, this is an oxymoron where many psychiatric hospitals are concerned - it will be possible to walk into an enclosed courtyard to smoke.
But for the majority of patients who are recently unwell, the one crutch over which they have control will be taken away from them.
At the very least this could aggravate psychosis and major depressive illnesses. It will make them feel even more tortured than they already do, leading to increased agitation and violent behaviour. For staff, an already difficult job will become even more of a challenge.
On a less dramatic scale, those who are unfortunate enough to require chronic psychiatric care will also be disadvantaged. The packet of fags won't be the ubiquitous friend it once was.
And what of the person dying of lung cancer who still smokes, reasoning that it is too late to quit? Having planned he would spend his last few weeks in a hospice, he is admitted 10 days before he dies. As the proposals stand he will be faced with going cold turkey for the last days of his life.
This situation will not be easy to remedy. If he is bedbound, the option of open-air courtyards is a non-starter. Even with a derogation to allow smoking rooms in hospices - and indeed hospitals, where some cancer patients continue to die - the kind of spontaneity that most of us would want to have in our last days will be impaired.
Rather than argue over diluting the effects of the ban in pubs, restaurants and clubs, the real debate should focus on these kinds of situations. Can we look forward to the Office of Tobacco Control and others addressing these substantive issues before it is too late?
You can e-mail Dr Muiris Houston at mhouston@irish-times.ie. He regrets he cannot answer individual queries