Eideard

In the global war against smoking, Europe remains a difficult battlefront. Despite ad campaigns featuring grisly images of rotting lungs and crumbling teeth, “the beautiful continent” continues to have the highest smoking rate in the world.

So forgive Iceland for considering something truly radical — prescription-only cigarettes. Under proposed legislation, only those with valid medical certificates would be permitted to buy cigarettes from pharmacies.

“I think Iceland can be a test tube to try out progressive things because we are a small country and we don’t have a massive lobby for tobacco,” said Thorarinn Gudnason, a cardiologist at Landspitali University Hospital in Rejkyavik. ”We are taking care of people who are dying of this disease in their 40s and we’re fed up with it.”

Iceland’s smoking rate is already one of the lowest in Europe. Just 15 per cent of the population lights up compared to an average of 31 per cent across the continent. However, the story among young Icelanders is more worrisome: 20 per cent of children and teenagers smoke. Dr. Gudnason hopes the new plan will dramatically reduce that figure and cut overall smoking rates to less than 10 per cent…

Tobacco and nicotine would be classified as addictive drugs and second-hand smoke would be treated and controlled like other carcinogenic substances. Lighting up in public places such as parks and in cars with children would be outlawed.

Eventually, smokers who are unable to kick the habit through treatment and various addiction programs — or those smokers who simply refuse to quit — may get a prescription for tobacco from their doctors. Once cigarettes become available only through physicians, the price will go down again — as it would be unfair to tax those unable to quit supporters of the plan say.

“Tobacco is very addictive and we would recognize them as addicts,” said Ms. Fridleifsdottir.

Bravo! Once again the political side of Iceland is willing to experiment with a daring approach to a disgusting problem. It would force a lot of people with lazy personal ethics to confront a personal problem. They can still maintain their addiction if they wish.

Saving their lives is a side effect.

Thinking about death can be frightening, no matter your age or medical condition. As we get older, the reality of our own mortality tends to come into clearer focus; this doesn’t make talking about death or life-sustaining treatments any less frightening though.

It was fear — stoked by certain politicians — that led to the inaccurate and misguided “death panel” rumors that surrounded health care reform proposals last year.

Beginning January 1, Medicare will reimburse physicians who advise patients, in voluntary discussions, about their preferences for end-of-life care treatment during their annual Medicare “wellness visit.” This is advance care planning, and it is a good thing for seniors, their families and health care professionals.

It’s not new. A law passed in 2008 allowed end-of-life planning to be part of a patient’s “welcome to Medicare” exam. Health care reform turned the welcome visit into an annual wellness visit. And now regulations clarify that these important discussions will be covered should the Medicare beneficiary wish to take advantage of this opportunity.

Advance care planning allows a person to make his or her wishes and care preferences known before being faced with a medical crisis. Advance care planning is simply smart life-planning.

RTFA. Many important details and suggestions about planning for the end of your future.

You can be smart. Or you can be stupid.