A leading Ulster cardiologist sparked controversy today by saying that smokers should not receive certain treatments on the NHS, including a heart by-pass, if they refuse to kick the habit beforehand.
Dr Mahendra Varma, a consultant at the Erne Hospital in Enniskillen, spoke of his frustration at the heavy pressure smoking-related illnesses, such as stroke and heart disease, place on the province's cash-strapped health service.
He said that smokers should have to give up their addiction at least three to six months before undergoing a major procedure, to increase the chances of a good recovery afterwards.
The past president of the Irish Cardiac Society added, however, that he had never come across a smoker in need of such treatment who did not want to give up.
"There is a significant waiting list for cardiac by-pass operations - at least six months which is not good enough," he said.
" Operations such as this are more difficult to perform on people who smoke. They are more prone to infections, they take much longer to recover, they have to spend longer in ICU afterwards and they have a higher mortality rate. The chance of post-surgery complication is very high.
" We do not live in a Utopian society, the Health Service does not have a lot of money."
Dr Varma, who is vice-president of the Northern Ireland Chest Heart and Stroke Association (NICHSA), stressed that he was not saying that anybody should be denied treatment.
"Smokers must give up cigarettes three to six months before an operation such as a by-pass if they are to have a good chance of recovery. There is good help available, such as at the smoking cessation clinic we have at the Erne, but it lies in the hands of the individual as well," he added.
Highlighting the pressure smoking-related illnesses place on the health service, Dr Varma said eight people die from one here every day.
Referring to UK-wide levels, he said: "It is the equivalent of a jumbo jet crashing every day at Heathrow airport with everyone on board dying. If that was happening, the Government would be up in arms. There would be a hue and cry."
Neil Rafferty, a spokesman for pro-smoking group Forest, said he was " disgusted" by the comments. "Smokers pay their taxes and national insurance the same as everybody else, they deserve the same NHS treatment whether they continue to smoke or not," he said.
"Where do you draw the line? Should this also apply to people with a bad diet? Or should a doctor refuse to treat a driver who has been seriously injured in a car accident because they were speeding? Once you start to apply thinking like this, there are very few patients who would be entitled to treatment."
The debate over healthcare for smokers comes after stroke sufferers and their carers presented Health Minister Michael McGimpsey with a report highlighting their dissatisfaction with NHS services for sufferers.