Today's news carries a story where a surgeon says that denying smokers orthopedic joint replacements, reconstructive surgery and other elective operations was justified in a health system with limited resources because it was more risky and expensive to operate on them.
There are many views on ethical dilemmas: making the most efficient use of resources for the common good creates many such dilemmas. Respiratory surgeon Matthew Peters' suggestion is, I believe, wrong, but it needs more than a cry of "you can't do that".
Dr Peters' position uses the base arguments of: operations on smokers are more risky; smokers take longer (that whom?) to recover from surgery; the benefits to smokers might not be as great as for others.
There are many groups of people for whom surgery is a higher risk than normal: people who use too much alcohol; drug users; those who have suffered significant trauma because of their own stupidity; people who play sports, and want to return to doing the same things; older people; and very young people. Denying surgery to one group of people who have a higher risk, but not targeting other groups is not a reasonable basis on which to operate (so to speak).
Some groups of people do take longer to heal, and need more time and resources from hospitals: very young infants, and older people are two such groups. Do you deny them surgery.
We do not deny people because of the cost. We do not say to any group "Sorry, this operation costs a lot, so you can't have it." Not to any group.
On what basis do doctors decide on surgery? Need, and benefits. Before any surgery, doctors will examine the risks and the benefits. They will discuss them with the patient, if that is possible. If the possible risks outweigh the possible benefits, it is likely that the surgery would not proceed.
For long-term smokers, the risks for some surgery might outweigh the benefits - but that needs to be judged on each individual case, not on a "class" of people. The same applies to all other cases.