Three researchers from the University of Pittsburgh in the United States pointed out in their research papers that the harm of e-cigarette is far less than that of cigarette, and "e-cigarette availability" (ECA) should be taken as a tobacco harm reduction strategy.
Ethics of tobacco harm reduction: analyzing the availability of e-cigarettes from the perspective of utilitarianism, bioethics and public health ethics
"E-cigarette availability" is a group intervention to encourage smokers to switch to e-cigarettes. It contains two meanings: let smokers clearly know that e-cigarettes are less harmful than cigarettes, and ensure that they can easily obtain e-cigarettes.
The author points out that "e-cigarette availability" is supported by two ethical frameworks: public health ethics and biomedical ethics. "E-cigarette availability" can help smokers reduce health risks and hazards, and allow smokers to make their own health decisions, which is in line with the principle of respecting individual rights and autonomy, and promotes social equity and justice. At the same time, using "e-cigarette availability" to achieve public health goals has the least restrictions than traditional tobacco control practices.
"The core of public health practice is to minimize the impact of bad behavior on public health, rather than completely eliminate bad behavior." the author stressed in his paper: "there is no conflict between paying attention to groups and respecting individual rights., (Public Health) officials and doctors should encourage smokers to use e-cigarettes and reduce violations of smokers' personal rights and freedoms."
"Whether smokers decide to quit smoking or switch to electronic cigarettes, we should show respect."
The biomedical ethics framework has proposed four principles, namely, respect for autonomy, kindness (increasing patient welfare), non malice (avoiding harm to patients) and justice. The harm of e-cigarette is far less than that of cigarette. Allowing smokers to switch to e-cigarette can enable smokers to avoid the harm brought by traditional tobacco. Therefore, it is in line with the principle of kindness and non malice.
More importantly, this scheme also fully meets the ethical needs of respecting the principle of autonomy.
Respecting autonomy means respecting the right of individuals to make informed decisions according to their own wishes. Providing smokers with e-cigarette products and e-cigarette harm reduction information can ensure that smokers make choices voluntarily according to their own values and preferences without any coercion and deception, which is an embodiment of respecting smokers' rights.
The ethical framework of public health always emphasizes that the realization of public health objectives should minimize violations of individual rights and freedoms. Even smokers who quit smoking in their later years have the right and freedom to pursue harm reduction. Their rights and interests also need to be protected.
"Everyone has the right to pursue happiness defined by himself. No matter whether smokers decide to quit smoking or switch to e-cigarettes, we should show respect," said Rebecca Thomas of the University of Pittsburgh, who is also one of the authors of this paper.
"Concealing and distorting e-cigarette information will make public health institutions lose credibility"
Since the individual rights of smokers should be respected, it is particularly important to provide accurate e-cigarette information in order to ensure that smokers make wise decisions.
"They (opponents of e-cigarettes) may say that it is safer to 'let the public overestimate the risk of e-cigarettes', but concealing and distorting e-cigarette information will lose the credibility of public health institutions. Once the credibility is lost, the public will question or even ignore other risk information released by them, resulting in major public health hazards."
Take the American lung disease reported by the media last year as an example. At that time, studies confirmed that the cause of this incident was the use of black market tobacco oil illegally added THC (tetrahydrocannabinol, a high concentration chemical extracted from industrial marijuana), which has nothing to do with regular e-cigarettes. The CDC once ignored the research conclusions and blamed the cause on ordinary e-cigarettes. It did not correct the relevant information until March this year.
The author believes that this approach seems to protect consumers, but in fact it does more harm than good: "it not only allows smokers who have switched to electronic cigarettes to smoke again, but also does not let everyone avoid the real culprit - black market thc products".
The public health ethics framework points out that the least restrictive interventions should be used to achieve public health goals. In terms of tobacco harm reduction objectives, the restrictions on providing e-cigarettes to smokers are less than those on banning e-cigarettes and all tobacco products, so it is in line with their ethical needs.
In addition, providing e-cigarette products and e-cigarette harm reduction information for smokers can also provide cheaper harm reduction programs for vulnerable groups, reduce the social health gap and promote social justice.
According to the data of the World Health Organization, tobacco causes more than 8 million deaths every year, and tobacco harm reduction is imperative. "A lot of evidence shows that e-cigarettes are much less harmful than cigarettes. Both the public health ethics framework and biomedical ethics framework prove that the availability of e-cigarettes is ethical and is a beneficial measure. Therefore, smokers should be encouraged to switch to e-cigarettes," the paper pointed out.