Dear Mrs. Bear,

I think Wes is simply not old enough to have a diagnosis of COPD. Some years have to pass before one can call something "Chronic".

Of course, it's bad for him to smoke, but smoking seems to calm people with mental illnesses like schizophrenia. There was a big ethical debate in the mental health community some years ago as to whether inpatient psychiatric patients, particularly those in custodial care, should be allowed to smoke. Almost all of them did up until then. Smoking seemed to relieve their anxiety and make their overall behavior calmer and more predictable. I don't know why. On the other hand, smoking causes COPD, heart disease, and cancer, and the Hippocratic Oath forbids medical professionals from causing harm to those under their care. I suppose that the debate was resolved in favor of either position on an institution-by-institution basis. Frankly, were I asked to decide, I would say, "Let them smoke". Their other problems are much more immediately critical. I would rather that they feel better now and for some decades to come at the expense of their longevity.

How old is Wes? In any case, I hope that the shrinks get a handle on his mental disorder soon enough to eliminate the risk that smoking causes. However, I think that your behavior is impeccable. He is lucky to have you as his mother.

Cordially,