Why are Psychiatric Hospitals Still Handing out Cigarettes? | Opinion
- Psych units supplying cigarettes exposes a troubling ethical double standard. A practice normalized for convenience would be unthinkable on cardiac or oncology floors.
- “Easier than withdrawal” prioritizes short-term management over long-term health. Providing cigarettes conflicts with core healthcare ethics: do no harm, act in the patient’s best interest, and ensure equitable care.
- This is a systems failure—not a staff failure. Under-resourced psychiatric settings have normalized practices that compromise both patient health and professional integrity.
A healthcare system reveals its ethical limits not in moments of crisis, but in the practices it normalizes.
During my psychiatric clinical rotation, I observed a routine practice that initially appeared benign: adult inpatients were permitted scheduled smoke breaks. Only later did I learn that the cigarettes were not simply allowed; they were supplied. Staff members collectively contribute money to provide cigarettes to patients because, as it was explained to me, “it’s easier than dealing with withdrawal.”
This justification, while common in psychiatric settings, raises serious ethical concerns. When examined through the foundational principles of healthcare ethics, nonmaleficence, beneficence, justice, and respect for persons, the practice becomes difficult to defend.
Nonmaleficence: Do No Harm
The principle of nonmaleficence obligates healthcare providers to avoid causing harm. Cigarette smoking continues to be the leading cause of preventable death in the United States, contributing to cardiovascular disease, cancer, and respiratory illness. Supplying cigarettes in a healthcare setting directly facilitates harm rather than mitigating it.
Nicotine withdrawal can be uncomfortable and distressing, particularly for psychiatric patients whose symptoms may already include agitation or anxiety. However, discomfort is not synonymous with harm, and it is neither clinically nor ethically appropriate to treat withdrawal symptoms by perpetuating addiction, especially when evidence-based alternatives such as nicotine patches, gum, and lozenges are widely available and effective, as well as medication to aid withdrawal symptoms.
Beneficence: Acting in the Patient’s Best Interest
Beneficence requires healthcare systems to promote patient well-being actively. Providing cigarettes may temporarily reduce irritability or behavioral disruption, but it does so at the expense of long-term health outcomes. This short-term stabilization prioritizes unit convenience over sustained patient benefit.
In other areas of medicine, we do not justify harmful interventions because they make care easier. We do not supply alcohol to prevent agitation in patients with alcohol use disorder, nor do we ignore dietary restrictions for the sake of compliance. Psychiatric care should not be held to a lower ethical standard simply because patients are more “challenging” to manage.
Justice: Equal Standards of Care
The principle of justice demands fair and equitable treatment across patient populations. The normalization of cigarette distribution in psychiatric units reflects a troubling double standard. It is difficult to imagine staff-funded cigarettes being provided on a cardiac unit, oncology floor, or surgical ward.
This disparity reinforces stigma surrounding mental illness by implicitly suggesting that psychiatric patients’ physical health is less deserving of protection. Equity in healthcare requires that mental health settings uphold the same commitment to preventive care and harm reduction as any other clinical environment.
Respect for Persons and Professional Integrity
Respect for persons includes honoring patient autonomy while also maintaining professional integrity. Providing cigarettes in an inpatient psychiatric setting blurs professional boundaries and places healthcare workers in ethically compromising roles. Staff are asked to personally finance and distribute substances known to be harmful, often without institutional policy guidance or support.
This practice also contributes to moral distress among healthcare workers, particularly students and early-career clinicians, who recognize the ethical conflict but feel powerless within understaffed and under-resourced systems.
A Systemic Issue, Not an Individual Failure
It is important to acknowledge that this practice does not stem from malice or neglect by frontline staff. Psychiatric units are frequently underfunded, understaffed, and overwhelmed. In such environments, practices that reduce conflict and maintain order can become normalized, even when they contradict ethical principles.
However, systemic strain does not absolve institutions of responsibility. If hospitals can implement structured protocols for alcohol withdrawal, pain management, and smoking cessation in other settings, they can, and should, do the same in psychiatric care.
Reimagining Ethical Psychiatric Care
Psychiatric patients deserve care that prioritizes both mental and physical health. Replacing cigarettes with comprehensive nicotine replacement therapy, patient education, and institutional support is not only feasible but it is also ethically necessary.
Mental healthcare should not be the domain where harm is quietly accepted because it is easier. Upholding ethical principles in psychiatric settings is not an idealistic aspiration; it is a professional obligation.
🤔Nurses, do you agree that psychiatric hospitals should stop the practice of providing patients with cigarettes? Share your ideas in the comments below!
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