Autonomía y heteronomía, una alianza necesaria para el abordaje del tabaquismo. Visión de profesionales y pacientes / Autonomy and heteronomy, a necessary alliance to address smoking cessation. Views of professionals and patients

Objetivo: Explorar la percepción de profesionales y pacientes sobre las cuestiones éticas que entraña la atención al tabaquismo en las consultas de atención primaria. Método: Se diseñó un estudio cualitativo. Se realizaron entrevistas semiestructuradas a 12 profesionales y 7 pacientes, y dos grupos focales con 6 profesionales y 7 pacientes de atención primaria (32 participantes en total). Se realizó un muestreo intencional buscando perfiles de profesionales y pacientes de ambos sexos, distintas edades y experiencia en relación con el tabaquismo. El análisis de contenido siguió una estrategia analítica inductiva desde los datos hasta la creación de categorías teóricas. Resultados: Se identificaron cuatro categorías principales: 1) cuestiones éticas relativas a la responsabilidad del/de la profesional con el/la paciente fumador/a; 2) cuestiones relacionadas con la actitud que debe mostrar el/la profesional ante el/la paciente; 3) aspectos relacionados con la justicia en la distribución de recursos y con el papel de la Administración pública en el control del tabaquismo; y 4) cuestiones relativas a la autonomía de la persona fumadora con respecto al consumo y al cese del tabaquismo. Conclusiones: Es necesaria una alianza entre la ética que favorece la auténtica autonomía de la persona fumadora y la regulación heterónoma del consumo de tabaco. Sería conveniente incluir estas cuestiones en los programas de formación para el manejo del tabaquismo por parte de los/las profesionales

Objective: To explore the perception of professionals and patients with regard to ethical issues involved in addressing the habit of smoking in primary care consultations. Method: A qualitative study was designed, consisting of 12 semi-structured interviews with professionals, 7 interviews with patients and 2 focus groups with 6 professionals and 7 primary care patients (a total of 32 participants). An intentional sampling was conducted, including profiles of professionals and patients of both sexes, different ages and experience in relation to smoking. A content analysis was performed with an inductive analytical approach from data to the creation of theoretical categories. Results: Four main categories were identified: 1) ethical issues related to the responsibility of the professional when treating patients who smoke; 2) issues related to attitude to patients who smoke; 3) issues related to fair and equitable distribution of resources and to the role of the different levels of government in relation to the control of smoking; and 4) issues related to smokers' autonomy regarding their habit and smoking cessation. Conclusions: An alliance is needed between the ethics that support the autonomy of patients who smoke and the regulation of tobacco consumption. This approach should be included in clinical training programmes dealing with tobacco use, dependence and cessation

The costs and benefits of a cigarette ban.

The death toll from tobacco is staggering: it might contribute to one billion premature deaths over the course of the 21st century. In 'The case for banning cigarettes', Kalle Grill and Kristin Voigt argue that the well-being and equality benefits of a complete ban on cigarettes more than justify the restrictions on autonomy that such a ban would impose. Their argument depends on two crucial simplifications: an assumption that the ban would be effective and the restriction of the analysis to a comparison with the status quo, rather than a broader range of policy options. I argue that despite the authors' claims, these two simplifications make it impossible for their argument to 'bring into focus the fundamental normative issues' surrounding a possible cigarette ban, since they dramatically overstate the benefits and obscure the most significant costs of such a ban.