Ethical analysis of the proposed Policies for Restricting the Use of “ENDS.”
The public health community is more divided than ever over an alternative to smoking than electronic cigarettes (e-cigarettes). Anecdotal information indicates that numerous individuals have quit using e-cigarettes, even though their efficacy as smoking cessation aids remains unclear. E-cigarettes, comparable to traditional cigarettes except for the use of a battery, can potentially lessen the adverse health effects of smoking significantly. However, there is much disagreement since there is no solid proof that the product is safe for people’s health. The potential for them to appeal to nonsmokers, to serve as a gateway to cigarette smoking, and to renormalize public smoking are only a few of the ethical concerns raised about their usage as recreational items and harm reduction technologies. To better comprehend the potential benefits to public health, we investigated the moral concerns raised by the widespread use of electronic cigarettes to reduce tobacco exposure. The contradictions between utilitarianism and liberalism in public health ethics are central to our paradigm, with utilitarianism seeking to maximize public health advantages by reducing illness burden as much as possible and liberalism placing a premium on people’s autonomy over their bodies.
While debating potential policy actions, ethical issues are sometimes tacked on as an afterthought. Problems are seldom seen as opportunities; instead, they are seen as roadblocks to reaching specified objectives when they arise. Conversely, ethical considerations should be central when establishing policy objectives and developing strategies for achieving them. Every choice between two or more possible courses of action or policies (including inaction) is ethical, at least to the extent that it affects the well-being of others in some manner.
Without attempting to abolish the practice altogether, harm reduction strategies instead work to mitigate its negative consequences. Typical uses include the supply of needle exchanges and safe injection kits to injectable drug users and using methadone to treat opiate addiction. Big data shows the effectiveness of harm reduction initiatives in public health, most notably in lowering the prevalence of HIV and Hepatitis C infection, despite persistent opposition to these strategies. E-cigarettes and tobacco harm reduction may be seen differently by skeptics than other kinds of drug addiction. Critics have voiced worries about the likelihood of a gateway effect of e-cigarettes towards traditional smokes, despite the lack of evidence that either e-cigarettes or needle exchanges encourage drug initiation among non-users(Franck et al.2014).
Furthermore, needle exchanges are not supported by influential political lobbyists or for-profit businesses as e-cigarettes are. When compared to the obviousness of smoking an e-cigarette in public, injecting drugs is far less noticeable. While the differences are noteworthy and need more investigation, they do not automatically rule out e-cigarettes’ potential to reduce damage.
Given the prevalence of smoking-related diseases, it is clear that innovative public health measures are required to lessen the risks of smoking. Standard nicotine replacement medications are authorized for usage for up to 12 weeks; hence almost all interventions have focused on the cessation of nicotine use. Despite the best efforts of everyone involved, only around 15% of smokers who are determined to stop were successful in remaining smoke-free for an entire year after receiving nicotine replacement therapy(Caponnetto et al.2011). Anti-tobacco activists have voiced concern that harm reduction might overshadow cessation messages, effectively reducing the number of successful quitters. However, an elimination-centred approach is inconsistent with the understanding that harm reduction strategies are more practical and feasible than enforcing population-wide abstinence.
Despite being advocated as a harm reduction option to combustible cigarettes among adults, there is no definitive scientific proof that ENDS are an efficient long-term quitting smoking assistance. According to a meta-analysis of 82 research done by Grana et al. 2014, e-cigarette usage among adults is most significant among current smokers, followed by ex-smokers. The researchers discovered that “dual usage,” or the use of electronic cigarettes in addition to conventional tobacco cigarettes, is widespread around the globe. Some worry that ex-smokers who use ENDS will be “renormalized” to smoking and will find it easier to start up again(US Department of Health and Human Services. (2014).
However, this rising ENDS usage pattern presents many difficulties for public health in the United States. According to a systematic study, nearly all teenagers are aware of e-cigarettes, indicating widespread knowledge of ENDS among middle and high school students. Another emerging evidence suggests that switching to traditional tobacco usage is more likely among those who use ENDS. ENDS is a gateway to smoking for many young people who would not otherwise start using combustible tobacco(Franck et al.2014). The rising popularity of ENDS has the potential to introduce nicotine addiction to a new generation of young people, which might renormalize smoking in society and therefore erode the public health achievements of the previous half-century.
Additionally, there has been a rise in the use of ENDS among marginalized groups, such as individuals with mental illness and people of colour. According to research by Forman-Hoffman et al., 56.4% of all cigarettes smoked in the US are smoked by persons with mental health issues(Caponnetto et al.2011). About half of all fatalities among those receiving mental health care are attributable to smoking-related disorders, making this population especially vulnerable to tobacco’s negative effects. At the same time, new research suggests that adults in the United States who are experiencing mental health issues are vulnerable to trying e-cigarettes; one study found that ex-smokers in the mental health system were six times more likely to be interested in trying e-cigarettes than those without mental health issues.
Several concerns have been expressed by those opposed to regulations that would outlaw the use of these devices in enclosed public spaces. First, critics say there is insufficient proof that being around someone using one of these devices inside can hurt them. Many critics point to research showing almost minimal danger. In addition, limiting access to these products may discourage individuals from engaging in “harm reduction” by switching from traditional cigarettes to ENDS. Some people are opposed to vaping devices because of the high cost of the equipment. In contrast, others believe that those who want to transition from traditional cigarettes should be able to try out the devices in a retail location. Opponents also wonder whether the risks to children from seeing this conduct modeled are sufficient to justify a ban on their usage in public buildings.
The policy mentioned above should be enacted so the general public can be protected from potential health risks associated with ENDS. Given the lack of definitive data on electronic cigarettes’ safety and effectiveness as smoking cessation aids, it is essential to set realistic risk limits based on an ongoing evaluation of the benefits and risks. Their popularity in the consumer market has skyrocketed, but an ethical framework to govern how they should be used has yet to catch up. In their capacity as tobacco harm reduction devices, e-cigarettes may significantly impact public health, according to the available data. In clinical practice, doctors have a moral obligation to provide patients with balanced risk assessments based on scientific data so that they may make educated decisions about whether or not to smoke. When it comes down to it, the goal of the smoking cessation strategy should be to enhance public health, which will entail certain compromises in the form of harm reduction. To craft a policy that respects individual agency while safeguarding societal health, it is necessary to be open to compromising with utilitarians and liberals. Even if it is essential to proceed with prudence in this area, it should be clear from the moral need to learn more about the product’s capabilities.
References
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Franck, C., Budlovsky, T., Windle, S. B., Filion, K. B., & Eisenberg, M. J. (2014). Electronic cigarettes in North America: history, use, and implications for smoking cessation. Circulation, 129(19), 1945-1952. https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.113.006416
Grana, R., Benowitz, N., & Glantz, S. A. (2014). E-cigarettes: a scientific review. Circulation, 129(19), 1972-1986. https://www.ahajournals.org/doi/abs/10.1161/circulationaha.114.007667
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