Mental health trusts across the UK have implemented a smoke-free agenda that the National Health Service in England and Wales will be smoke-free by December 2006. ¹ ‘Smoke-free’ means that smoking will not be permitted anywhere within hospital grounds, with no exceptions for staff or visitors and limited exemptions for certain patients, providing no one is subject to passive smoking as a result. ^{Reference O'Gara and McIvor2} Although this is acceptable in order to maintain government legislation on smoking in public places, one has to ask whether these rules should also apply to domiciliary visits?

If smoking by a service user, in their home, interferes with the doctor–patient consultation, then should the clinician be able to insist that the patient stop smoking, or is this a breach of their human rights? We have experience of domiciliary visits where the patient has insisted on smoking cigarettes during the consultation, despite requests to stop. As such visits may arise in the context of Mental Health Act assessments or urgent reviews, they may be perceived to be stressful by the patient, hence providing justification for smoking to relieve tension.

However, passive smoking is not only detrimental to the clinician's health. It may also have a negative impact on the therapeutic alliance, if the issue is confronted. And surely doctors’ human rights are just as important as patients’?