I had a friend put a bee in my bonnet. It could be argued that it was always there but I shall defer a degree of credit to him. The issue is hospitals making smoking illegal for psychiatric patients.

My health or lack thereof is still “my” health. When we crowd individuals with serious and persistent mental illness off hospital grounds to smoke the message is, “we want to make you healthy and we refuse to enable non-healthy behaviours.” It appears to be an admirable avenue but it is still a slippery slope. If non-smoking initiatives are embraced it enables preventing patients from any behaviour including ingesting pizza and pop.

Obesity is as problematic as smoking. Will it be next or can we continue to consume chocolate? A serious and widespread side effect of some psychiatric medications is weight gain. If it is prescribed by a psychiatrist there seems to be no dilemma but if I thrive on soda pop it is unacceptable. I knew individuals who were policed for their pop consumption. The one individual I recall most was allowed to drool uncontrollably but liquid running in the other direction was monitored and measured.

If your argument is that second hand soda doesn’t affect others I would have you stand at the side of a highway or avenue and measure the cocktail of car exhaust you breathe in. When I first arrived at the forensic hospital in St. Thomas we had smoking rooms with cushioned chairs and TV’s. I quit for a period and don’t recall any smoke in the hallways. The smoke was contained in a humane way using air exchangers. The smoking rooms were closed while I was there but the asbestos and lead paint didn’t seem problematic.

Unfortunately, these well meaning but overbearing boardroom bureaucrats fail to fathom the positives and pleasures of smoking. We can all relate to the benefits of joining friends for a beer or meal and smoking is no different. Should relative health supersede happiness and free will? Even the executioner has the mercy to offer the beneficiary of bullets a cigarette as a last wish. Smoking is unhealthy and slightly disgusting but for a depressed patient it may offer four minutes of pleasure. It can be a reminder of normalcy and freedom in a situation of caregiver custody.

There are more productive pleasures but who doesn’t choke on other people’s ideas of what they should be doing with their Loonies, lungs or legs? Autonomy must be complete and absolute wherever possible and practical or else patients are essentially prisoners.

I was in Stratford Jail when the province issued a smoking ban in those institutions. I remember a notice in Admitting and Discharge:

“The jail will be smoke free as of November 22nd. We suggest you either quit smoking or stay out of jail.”

Hospitalization is not a choice or a poor decision. To deny a patient a pleasure they are likely addicted to on the street is punitive, cruel and misguided. If you choose not to smoke I admire you but don’t deny me the dignity of my own decisions. Don’t put me in the cold and rain on the side of the highway in the guise of care or because of your self-righteous beliefs and behaviours. Others are not stupid or wrong they simply have other priorities, likes and habits.

To deny an individual dependent on tobacco as a coping pleasure is nothing more than institutional primacy which places patients beneath the institution.