I once had a 30-year-old patient that was in a severe car accident that left him with a traumatic brain injury. The patient was permanently wheelchair bound but completely oriented and able to communicate. He was brought to my clinic by his home health provider and multiple family members. They were all arguing loudly as I entered the room. The conflict was due to the fact that they had stopped buying him cigarettes when they would go out shopping for him and they would not allow him to buy any when he was out with them.
I think the whole room was shocked to discover how quickly I sided with the patient. I told the caretakers, “You are not taking care of an eight year old child, this is a thirty year old man. If the man wants cigarettes, it is not your place to stop him”.
As the man smiled at his family with vindication, I turned to him and said “Their job is help you provide for your needs, my job is to explain to you how idiotic it is to continue smoking in your current condition”. I spent the next fifteen minutes describing the physiological effects of smoking. I explained the increased risk of stroke and how his life would be negatively effected if his condition deteriorated even slightly further. I basically frightened the living hell out of him.
Over the course of the next few months, the patient weaned himself down and eventually completely off of cigarettes. He did this on his own terms and was filled with a sense of pride. Both he and his caretakers thanked me for the unusual way that I handled their conflict.
As a society, we have become too paternalistic. We have reached a point where we feel justified in forcing our own opinions on other adults because we think that we know what is good for them. We rob others of their autonomy. Regardless of our intentions, it is morally wrong. If you want someone else to change their behavior, then all you should really have to do is present a convincing argument.
