Pursuing reflective equilibrium when hospital patients smoke.

Questions about smoking policies in hospitals, and how exactly to implement them, have been difficult to answer for many years. Policy-makers must consider a tangled web of personal versus public goods. Administrators often have to creatively decide how policies can best be adopted at their particular site. Clinicians and hospital staff must then implement those policies, often compelling them to consider whether a slight violation might be in a particular patient's interest, and then whether to assist in the violation or not, and whether to share their decisions with colleagues. Getting such questions right can have important consequences for the wellbeing of patients, administrators, and clinicians alike, so a careful balancing of the issues is warranted.