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Smoke and Mirrors: One Case for Ethical Obligations of the Physician as Public Role Model


As a result of workplace clean air regulations and strict guidelines imposed by the Joint Commission on Accreditation of Healthcare Organizations in 1993, most hospitals in the United States are now virtually smoke free. Although evidence suggests that these restrictions both cause smoking employees to consume fewer cigarettes per day and induce some employees to quit smoking entirely, the policies have also driven many healthcare providers—including physicians—onto the public sidewalks for their cigarette breaks. Patients entering many hospitals pass white-coated medical students and residents puffing away at the curbside.

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1. Longo D, Brownson RC, Kruse RL. Smoking bans in U.S. hospitals. Results of a national survey. JAMA 1995;274:488–91; see also Barinaga-Burch S, Bergman J. Tobacco: A legal and policy issue of the elderly. Clearinghouse Review 1996;30(6); available at (accessed Sept. 28, 2008).

2. Hudzinski L, Frohlich E. One year longitudinal study of a no smoking policy in a medical institution. Chest 1990;97:1198–202.

3. Longo D, Brownson RC, Johnson JC, Hewett JE, Kruse RL, Novotny TE, Logan RA. Hospital smoking bans and employee smoking behavior. JAMA 1996;275(16):1252–8.

4. Olive K, Ballard J. Attitudes of patients toward smoking by health professionals. Public Health Reports 1992;107(3):335–9.

5. Dawley HH Jr, Carrol SF, Morrison JE. The discouragement of smoking in a hospital setting. International Journal of the Addictions 1981;16:905–10.

6. See note 4, Olive, Ballard 1992.

7. Wright S, Carrese J. Serving as a physician role model for a diverse population of medical learners. Academic Medicine 2003;78(6):623–8; Levinson W, Kaufman K, Clark B, Tolle SW. Mentors and role models for women in academic medicine. Western Journal of Medicine 1991;154(4):423–6; Wright S. Examining what residents look for in their role models. Academic Medicine 1996;71(3):290–2.

8. Physicians as role models in society. The Western Journal of Medicine 1990;152(3):292; The physician as role model. South Dakota Journal of Medicine 1994;47(10):347–8.

9. Raymond v. Board of Registration 387 Mass. 708; 443 N.E. 2d 391 (1982).

10. B.W. v. Board of Medical Quality Assurance, 215 California Reporter. 130, 135 (1985); Furer v. Sobol, 576 N.Y.S. 2d 632, 633 (1991).

11. Annual smoking-attributable mortality, years of potential life lost, and economic costs—United States, 1995–1999. Morbidity and Mortality Weekly Report 2002;51(14):300–4.

12. Prevalence of current cigarette smoking among adults and changes in prevalence of current and some day smoking—United States, 1996–2001. Morbidity and Mortality Weekly Report 2003;52(14):303–7.

13. Mill JS. On Liberty. New York: Penguin Books; 1983:72.

14. Stewart L. Smoking and Civil Rights. Available at;accessed Nov. 19, 2003.

15. Viscusi WK. Constructive cigarette regulation. Duke Law Journal 1998;47:1095.

16. Pope TM. Balancing public health against individual liberty: The ethics of smoking regulation. University of Pittsburgh Law Review 2000;61:419.

17. Dent v. West Virginia, 129 U.S. 114; 9 S. Ct. 231; 32 L. Ed. 623 (1889).

18. Humenansky v. Minnesota Bd. of Medical Examiners, 525 N.W.2d 559, 563, n.1 (1994).

19. See note 4, Olive, Ballard 1992.

20. Martinez M. Mays, Mantle reinstated by baseball commissioner. New York Times 1985 Mar 19.

21. Black Sox to Rose: The shades of scandal. USA Today 1991 Jun 25.

22. Palmer T. Giving baseball a bad name. Boston Globe 1992 Dec 6.

23. See note 22, Palmer 1992.

24. Brousard C. Ward is contrite after stern rebuke. New York Times 2001 Apr 24.

25. Fulmer J. Dismissing the “immoral” teacher for conduct outside the workplace—Do current laws protect the interests of both school authorities and teachers? Journal of Law & Education 2002;31:231.

26. Sullivan v. Meade County Independent School District No. 101, 387 F. Supp. 1237 (1975); Brown v. Bathke, 566 F.2d 588 (1977).

27. In re Hale 723 N.E.2nd 206 (Illinois 1999).

28. In re Grahan 279 N.W.2d. 826 (Minnesota 1979).

29. Wild v. United States Dept. of Housing and Urban Development, 692 F.2d 1129, 1130 (1982); Illinois bill would ban tongue splitting. USA Today 2003 May 13.

30. Railway Express Agency v. New York 336 U.S. 106 (1949).

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Cambridge Quarterly of Healthcare Ethics
  • ISSN: 0963-1801
  • EISSN: 1469-2147
  • URL: /core/journals/cambridge-quarterly-of-healthcare-ethics
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