Bonnie is a 54-year-old woman with a history of congestive heart failure and COPD. She describes herself as a “pack-every-other-day” smoker and has smoked cigarettes for most of her adult life. She was diagnosed with COPD several years ago, which has led to multiple hospitalizations and ongoing complications.

She reports having several other conditions, including depression and anxiety, and states that smoking cigarettes is “the least of [her] concerns.” During her most recent hospitalization for shortness of breath, the medical team explained that if she does not make an effort to stop smoking, her quality of life and life expectancy will continue to decline. The team further noted that if she continues to smoke, there is little they can do to improve her condition.

When Bonnie heard this, she became angry and expressed her frustration. She stated that she does not believe smoking causes health problems, noting that her father was a lifelong smoker who smoked until the day he died at the age of 94, without any apparent smoking-related illnesses.

Bonnie maintains that healthcare professionals “don’t really know the truth” about smoking and are “always wrong or changing their minds.” She added, “Tomorrow they might say that smoking is actually good for you, so I’m going to believe what I believe.”

The medical team is uncertain how to proceed with treatment, and an ethics consult has been requested.