For moral autonomy, it is more important to make wrong choices than to obey instructions," writes Michael Fitzpatrick in this week's Head to Head debate (doi: 10.1136/bmj.h5654). A ban on smoking in psychiatric hospitals would, he says, cause distress to patients and conflicts with staff. Mental health clinicians should focus on the treatment of mental illness and leave wider health decisions "to those entitled and qualified to make them—the patients. But what are the limits to patients, autonomy?
How much should clinicians constrain choice in the name of a patient's best interests? On the other side of the debate, Deborah Arnott and Simon Wessely say that they can't condone "patients smoking themselves to death while in our care" (doi:10.1136/bmj.h5654). England's Court of Appeal has ruled that smoking is not a fundamental human right, and since one London trust adopted a smoke-free…
