Smoking and Human Rights: Tobacco Endgame Under Ethical Considerations

Is Full Tobacco Control Ethical?

Human usage of tobacco has a long history of over 500 years. Until recent decades, tobacco usages, especially smoking, were entirely unregulated in the world. In United States, because the government lacked proper evidence that confirmed the link between tobacco usage and disease, cigarette control measures only emerged after the 1960s. In addition to insufficient proofs of the danger of tobacco, the addiction to nicotine was confirmed in the late 1990s only. Nowadays, after 60 years of consistent efforts by organizations and agencies, governments have put a complex of anti-tobacco policies such as imposing warning signs, banning advertising, taxation, implementing clean air act and age limits. Due to the progress made by these measures, smoking prevalence in the global context has been reduced considerably, especially in high-income countries. Consequently, organizations and governments now shift their interests into the endgame strategy, which aims to completely eliminate cigarette usage by a certain time in the future. However, the debate on ethical issues around tobacco control also draws a substantial amount of attention. Pro-smoking population argues that it is not ethical to completely phase out tobacco usage considering under the framework of human rights. By addressing both sides of the debate on tobacco endgame proposal and examining the ethical concerns under human rights framework, this paper will argue that the proposal of “tobacco-free generation” works accordantly with the existing ethics framework.

TFG 2000 Proposal

In recent years, proposals on completely banning tobacco usage by certain time are popular because according to the World Health Organization (WHO), existing tobacco regulation policies can only reduce smoking prevalence by 15-25%.^[1] Among these endgame proposals, “Tobacco Free Generation 2000” (TFG2000) prohibits supplying tobacco products of any kinds to people who born after 2000, aiming to complete eliminate tobacco usage in the future. Although there are a substantial amount of efforts on tobacco control, smoking and other tobacco-related behaviors continues to cause 6 million deaths world-widely.^[2] TFG was published in 2019 and then got strong public support in Asia countries such as Singapore and Malaysia.^[3] In social and cultural perspectives, this proposal aims to convey the message to the young generation that despite smoking is still a popular social behavior, tobacco usage is not a proper way to socialize and to entertain. In an economic perspective, comparing to other radical proposals, this measure slows down the reduction in tax revenue, which allows the government to continue allocating this part of the revenue to subsidize public health sector. According to Yvette Van der Eijk and Gerard Porter, the TFG 2000 has also received support in terms of both legislation and public opinion in Tasmania, Guernsey, Finland and New Zealand.^[4]

What is Human Right

To be able to engage in the debate on tobacco control and human rights, one has to fully understand the framework of human rights. Human rights are fundamental values established to inherent to all human beings regardless of race, sex, nationality, ethnicity and religion. Human rights are given to everyone without discrimination. The current standard and framework of human rights are defined by United Nations Human Rights (UNHR) with four documents including Universal Declaration of Human Rights (UDHR),[5] which is the main discussion in this paper. Depending on different legal systems these frameworks are exercising in, different states have various interpretations to practice those values. However, the way many pro-smoking activists interpret these frameworks is often misleading and flawed.

Human Rights of Life and Second-Hand Smoke

Due to the great danger and risk imposed by second-hand smoke, TFG 2000 does not harm smokers’ human rights of life. Instead, it works compatibly with human rights by providing a more appropriate protection to non-smokers. Pro-smoking advocate often interprets the human rights to life as it gives people right and freedom to enjoy the cigarette. However, because of the danger of second-hand smoke that posed by smokers, the human right does not grant smokers the right to pose harmful effects on others. Instead, the TFG 2000 provides protection to non-smokers’ human rights of life and health. According to the Center for Disease Control and Prevention (CDC), second-hand smoke is defined by smoke from burning tobacco products and smoke exhaled or breathed out by smokers.^[6] “The effects of SHS, especially in children, are worth noting: passive exposure to parental smoking leads to middle ear infections, respiratory diseases including asthma, the worsening of serious conditions such as cystic fibrosis and asthma, and in some cases, death”.[7]

In addition to the harm for children, since 1964, approximately 1,500,000 non-smokers have died from health problems caused by exposure to second-hand smoke. Due to these risks, using the human rights to argue smoking as the individual choice is flawed. In addition, although governments have already imposed restrictions on public smoking, these regulations are not sufficient to fully eliminate the effects of second-hand smoke. For example, in the United States, the current law of regulating on tobacco in public area does not fully protect non-smokers’ human rights that during 2011 to 2012, there were still 58 million non-smokers in the US were exposed to secondhand smoke.[8] In conclusion, TFG 2000 is ethical in terms of human rights of life by being able to offer better protection to non-smoker.

Human Rights of Life for Smokers

In addition to protecting the human rights of non-smokers, under the human rights ethical framework, TFG 2000 also offers protection to smoker from addiction. According to the Convention on Rights of the Child (CRC), the government should take the responsibility to ensure children to survive and develop healthily. According to CDC, “9 out of 10 cigarette smokers first tried smoking by age 18, and 98% first tried smoking by 26”.[9] Most smokers start smoking before they have fully developed their rationalized decision-making mechanism. When they have abilities to make decisions considering long-run effects, they already addict to tobacco usage. In low-income countries, poor people easily become victims of social pressure and start smoking before adulthood. For example, in China, especially the northwest region, there are 60 millions of left-behind children who have no sufficient parenting during their adolescence. Youth smoking rate also maintains at a high level comparing to other regions. Once children have initiated smoking habits, nicotine addiction makes it extremely hard to quit. 

In addition to the harmful effect on children, adult smokers are also victims of nicotine addiction. Novotny and Carlin argue that “persons are deemed to have autonomy on the basis of their nature as rational and moral beings. Preservation of individual autonomy requires both information about a health risk behavior, and voluntary choice (that is, without nicotine addiction)”.[10] According to Novotny and Carlin, tobacco control is to protect the human rights of smokers instead of violating them. From the supplying perspective, TFG 2000 complete eliminate tobacco and nicotine addiction for good gradually. Hence, it is ethically right to implementing government regulations such as TFG 2000 to ensure the health of smokers considering the human rights framework. 

Human Rights of Self-Determination

Under the framework of human rights of self-determination, TFG 2000 again is ethical because of tobacco’s property of addiction and harm to others. Another human right granted by UNHR is the freedom of self-determination, which is defined by UDHR as to “freely pursue economic, social and cultural development”.[11] Pro-smoking advocates often argue that smokers have rights given by the human rights of self-determination, to freely choose to smoke and to risk their health. However, this argument is flawed that it neglects the negative impact of smoking on the development of human society. The freedom of self-determination is valid when the economic, social and cultural development is not destructed. In the case of smokers, “tobacco-related illnesses and deaths have adverse socioeconomic consequences for families, communities, healthcare systems and public resources”.[12]

Other than the overall social impact, the so-called “self-choice” of smoking also harm others because of second-hand smoke as mentioned before. So, it is unethical to assume smoking is a purely individual decision. In addition, smoking also violates the idea of liberty because of the addiction property of tobacco products. Thus, the decisions of using tobacco are not entirely made by smokers since they have no controls over the addiction to nicotine. So instead of being a pro-smoking argument, due to the property of addiction and the negative impact of tobacco on human development, human rights of self-determination is actually a good interpretation of why TFG 2000 proposal is ethical.

Inequality to Adolescent and Poor Group

Although endgame proposals such as TFG 2000 work compatible with human rights frameworks as discussed above, the pro-smoking group may still argue that adolescent and the poor socioeconomic group would be affected more, which negatively affects the overall equality of the society. Thomas and Gostin in their article “Tobacco Endgame Strategies: Challenges in Ethics and Law” argue that “suppose that endgame strategies reduced tobacco prevalence to 5%: higher socioeconomic classes might decline to 1–2%, with double-digit prevalence among the poor, less educated or mentally ill”.[13] According to this journal article, the ratio of the population benefited or affected by this proposal is different among different socio-economic groups. As the result, the existing health disparities and social inequalities would be dramatically increased. In this case, Thomas and Gostin argue that TFG 2000 should pivot to focus on benefiting poor and adolescence.  

Nicotine addiction and the Cultural Concern of Tobacco Control

Nicotine addiction is the fundamental reason that government should advocate TFG 2000 to protect both active smokers and potential smokers. However, Thomas and Gostin address that adults may smoke the cigarette for various personal reasons such as anti-anxiety or controlling weight gain.[14] For existing smokers, endgame policies would gradually generate a cultural environment that put a lot more guilt, social pressure and even discrimination against smokers. Due to the fact that nicotine is highly addictive, existing smokers would have hard times fitting into society and quitting tobacco. In some cases, they may look for other alternatives for tobacco such as hard drugs.

Conclusion

This paper has discussed both sides of the debate on tobacco control, especially focused on endgame strategies such as TFG 2000. In conclusion, although TFG 2000 may harm existing smoker and jeopardize the overall social equality, this proposal is still considered ethically good under the human rights framework. Exercising an aggressive tobacco control policy does not violate ethical values under the human rights framework. In addition, it works compatible and consistent with those human rights.

Bibliography

• Centers for Disease Control and Prevention. ”Vital Signs: Disparities in Nonsmokers’ Exposure to Secondhand Smoke—United States, 1999–2012.” Morbidity and Mortality Weekly Report 64 (4) 2015.103–8.
• Eijk, Yvette Van Der, and Gerard Porter. “Human Rights and Ethical Considerations for a Tobacco-free Generation.” Tobacco Control 24, no. 3 (2013): 238-42.
• Khoo D, Chiam Y, Ng P, et al, “Phasing-out Tobacco: Proposal to Deny Access to Tobacco for Those Born from 2000.” Tobacco Control 19, no. 5 (2010), 355–60.
• Novotny, T. E. “Ethical and Legal Aspects of Global Tobacco Control.” Tobacco Control14, no. 2, (2005): 26-30.
• Thomas, Bryan P., and Lawrence O. Gostin. “Tobacco Endgame Strategies: Challenges in Ethics and Law.” Tobacco Control 22, no.1 (2013): 55-57.
• U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.
• UN General Assembly, “Universal Declaration of Human Rights,” 217 (III) A (Paris, 1948).
• World Health Organization, “Mortality Attributable to Tobacco”. New York, 2012, 8.

^[1] World Health Organization, “Mortality Attributable to Tobacco”. New York, 2012, 3.

^[2] World Health Organization, 8.

^[3] Khoo D, Chiam Y, Ng P, et al, “Phasing-out Tobacco: Proposal to Deny Access to Tobacco for Those Born from 2000.” Tobacco Control 19, no. 5 (2010), 355–60.

^[4] Eijk, Yvette Van Der, and Gerard Porter. “Human Rights and Ethical Considerations for a Tobacco-free Generation.” Tobacco Control 24, no. 3 (2013): 238-42.

[5] UN General Assembly, “Universal Declaration of Human Rights,” 217 (III) A (Paris, 1948).

^[6] U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

[7] Van Der, and Porter, 240.

[8] Centers for Disease Control and Prevention. ”Vital Signs: Disparities in Nonsmokers’ Exposure to Secondhand Smoke—United States, 1999–2012.” Morbidity and Mortality Weekly Report 64 (4) 2015.103–8.

[9] U.S. Department of Health and Human Services. 

[10] Novotny, T. E. “Ethical and Legal Aspects of Global Tobacco Control.” Tobacco Control14, no. 2, (2005): 26-30.

[11] Van Der, and Porter, 241.

[12] Van Der, and Porter, 240.

[13] Thomas, Bryan P., and Lawrence O. Gostin. “Tobacco Endgame Strategies: Challenges in Ethics and Law.” Tobacco Control 22, no.1 (2013): 55-57.

[14] Thomas, and Lawrence, 56