Bioethics Discussion Blog: The Ethics of Smoking

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Saturday, April 25, 2009

The Ethics of Smoking


From the Centers of Disease Control and Prevention here are the current statistics about the prevalence of smoking cigarettes.

Current Cigarette Smoking
In 2007, the median prevalence of adult current smoking in the 50 states and DC was 19.8% Among states, current smoking prevalence was highest in Kentucky (28.3%), West Virginia (27.0%), and Oklahoma (25.8%); and lowest in Utah (11.7%), California (14.3%), and Connecticut (15.5%). Smoking prevalence was 8.7% in USVI, 12.2% in PR, and 31.1% in Guam. Median smoking prevalence among the 50 states and DC was 21.3% (range: 15.5%--28.8%) for men and 18.4% (range: 8.0%--27.8%) for women. Men had a significantly higher prevalence of smoking than women in 30 states, DC, and all three territories.

Trends in Cigarette Smoking
During 1998--2007, linear decreases were observed in 28 states, DC, and PR. Nonlinear trends were detected in 19 other states. Trends in smoking prevalence varied among these states; however, all had reached a peak prevalence before 2004 and then began to decrease. Among 16 of these 18 states, logistic regression models indicated that the prevalence decreased during 1998--2007; in the other two states no change in prevalence occurred. No change over time in smoking prevalence (quadratic or linear) was observed in Alabama, Arizona, Tennessee, and West Virginia.


The host of medical consequences of smoking is clear as can be read in the Executive Summary of the U.S. Surgeon General’s 2004 Report with studies showing damage to organs beyond the lungs and heart and the resultant personal impact in terms of chronic symptoms but also the personal and society-wide effect on productivity and medical time and financial expenditure. Further, there is the documented health effects of those exposed secondarily to a smoking environment.
The need for breaking the tobacco habit and reducing smoking within the United States is obvious. For years various approaches have been begun by the government, institutions and the medical system including ban on certain advertising, anti-smoking campaigns and public and patient education through the media and by the medical profession along with medical approaches to reduce the tobacco craving. As seen by the CDC statistics, there has been some improvement in reduction of smoking but has not reached hoped for goal of about 12%.

Now, what does ethics have to do with smoking? If smoking is a personal right and liberty, on what ethical argument can government restrict the citizen’s autonomy for smoking and for example restrict where a person can or can’t smoke? Autonomy can be preserved unless through the action of an individual there is potential harm to others. Philosopher Thaddus M. Pope has written a paper for the University of Pittsburg Law Review which dissects the ethics involved. If you are a smoker, how do you feel about the restrictions put on you on where you can smoke and which limit your autonomy to smoke? Do you think you should be “your brother’s keeper”?..Maurice.

7 Comments:

At Thursday, May 07, 2009 1:39:00 PM, Anonymous Anonymous said...

As a hospital administrator I have been struggling with this very issue. While we have a committment to improve the health and lives of our community, do we do so at the expense of freedom? We are currently considering a policy wherin we will discharge patients mid-therapy who insist on leaving the hospital to smoke against medical advice. I find this proposal disturbing from many points of view not the least of which is "to do no harm". Discharging a patient because he/she wants to participate in legal but unhealthy behavior conflicts with my personal values. We care for many patients who participate in unhealthy behaviors. Its part of the job and creed as a nurse. I personnaly believe the line on smoking starts with impact to others and ends with personal choice. If an argument can be made that you are impacting the health of another then your freedoms/choices can be challenged. If this argument cannot be made then we as an institution have no say...as long as that behavior is still deemed lawful by our society.

Lastly, eating meat, not excercising, getting stressed, watching TV, consuming trans fats, having sex...if we refuse to treat those that participate in activities we do not approve of but are lawful where will it end?

Sincerely, Looking for America?

 
At Thursday, May 07, 2009 2:23:00 PM, Blogger Maurice Bernstein, M.D. said...

One could argue that a person smoking, while legal and if not exposing another person to the smoke, in the immediate sense makes punishment for that current smoking unjust. However, even if that person will smoke in an environment never to breathed by another person, the smoker, nevertheless, over a period of years may develop chronic obstructive pulmonary disease and/or lung cancer as examples which will can put an economic if not a medical resource burden on other citizens, even if the smoker has insurance. It is this long term effect and unnecessary burden on society that should be something each smoker should be aware and consider and motivate the smoker and his or her family and physicians to encourage terminating the habit.

Discharging the patient for smoking while as a hospital patient and who still requires medical treatment is neither ethical nor of habit-terminating value. ..Maurice.

 
At Monday, May 11, 2009 12:45:00 AM, Anonymous No Tobacco said...

We are born in a smoke free world and it is just right that we strive to offer our children the same kind of environment. Be involved and help empower everyone by taking part in the yearly WORLD NO TOBACCO DAY which will be on May 31st!

 
At Saturday, August 01, 2009 7:44:00 AM, Anonymous Ryan said...

I think everyone should have the right to do as they please as long as they are not aversely affecting others.

I used to smoke myself so I understand the pressures on both smokers and non, its a difficult addiction to quit but people need to realise there are plenty of alternatives.

Nicotine gum is absolute crap, I found the thought of chewing it horrifying when I was still smoking.. It made me want to smoke more.

However e-cigs are coming into force now and they do provide a great alternative.... sure you will still be a nicotine addict but your addiction doesn't have to kill you any more.

The book that helped me quit was "Alan Carr's easy way to stop smoking" I was so happy I had quit after reading it I bought copies for a few friends but they haven't read it just yet... Mostly due to the fear of giving up which the book actually addresses.

 
At Saturday, August 01, 2009 8:19:00 AM, Blogger Maurice Bernstein, M.D. said...

By the way, the Food and Drug Administration (FDA) in the United States has recently found some health related contaminants in several brands of "e-cigarettes".

Ryan or others, what do you think of President Obama as some role model (either positive or negative) regarding the smoking habit?

By the way, in terms of healthcare reform in the U.S., there is no doubt that getting the population to rid the habit of smoking would save the billions of dollars needed to provide healthcare for the uninsured. The consequences of smoking on the costs of medical care from chronic obstructive pulmonary diseasee and lung cancer and cardio-vascular disease along with the debility of the symptoms which lead to inability to work all can account for those dollars.

Ryan, good luck on staying nicotine free. ..Maurice.

 
At Friday, October 09, 2009 2:47:00 PM, Anonymous Anonymous said...

Smoking is bad for an individual's overall health.Instead of complaining about a person's free will right to smoke, offer better smoking reform as well as clinics and follow up. I think that threatening to dock $25.00 from an employee's check every two weeks is a form of corporal punishment. Do you think that most smokers would like to quit smoking. I am a Registered Nurse, and I see all forms of addictions at the hospital where I am employed.Our Insurance company Cigna) is threatening their employees who will not quit smoking with a dock in pay of $25.00 per pay period, until they decide to quit. The employees must have quit for 12 weeks before they can be reimbursed the so-called surcharge. This is a violation of these employees First Amendment Rights. if a person chooses to smoke in the privacy of their own home, or in their vehicle, who's business is it? If the public is so worried about smoke, then don't put yourself in harm;s way. Mind your business and supply proof that you are genuinely concerned about that person's welfare. Thank you! Sassy R

 
At Sunday, December 13, 2009 1:05:00 PM, Blogger Maurice Bernstein, M.D. said...

For those interested in an artistic and educational graphic about the medical consequences of smoking on the smoker's body, simply go to this link. ..Maurice.

 

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