Tobacco harm reduction research in the United States: encouraging smokers to switch to electronic cigarettes conforms to public health ethics

Public health ethics emphasizes that the realization of public health goals should “minimize the violation of individual rights and freedoms”. Whether smokers decide to quit smoking or switch to e-cigarettes, we should show respect.

Recently, 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 that “e-cigarette availability” (ECA) should be regarded as a tobacco harm reduction strategy.

Tobacco harm reduction Ethics: analysis of e-cigarette usability from the perspective of utilitarianism, bioethics and public health ethics

“E-cigarette usability” is a group intervention to encourage smokers to switch to e-cigarettes. It has two meanings: let smokers know clearly that e-cigarettes are less harmful than cigarettes, and ensure that they can easily obtain e-cigarettes.

The authors point out that the usability of e-cigarettes is supported by two ethical frameworks: public health ethics and biomedical ethics. “E-cigarette usability” can help smokers reduce health risks and hazards, and allow smokers to make their own health decisions, in line with the principle of respecting individual rights and autonomy, and promoting social equity and justice. At the same time, the use of “e-cigarette usability” to achieve public health goals, compared with the traditional tobacco control practices, encountered the least restrictions.

“The core of public health practice is to minimize the impact of bad behavior on public health, rather than eliminate it completely.” “There is no conflict between paying attention to groups and respecting individual rights,” the author stressed in the paper

“Whether smokers decide to quit smoking or switch to e-cigarettes,

We should all show respect. “

The biomedical ethical framework has proposed four principles, namely, respect for autonomy, benevolence (increasing patient welfare), non malice (avoiding harm to patients) and justice. The harm of e-cigarette is far less than that of cigarette, so it is in line with the principle of benevolence and non malice.

What’s more, this program fully meets the ethical needs of respecting the principle of autonomy.

Respect for autonomy means respecting the right of individuals to make informed decisions according to their own wishes. Providing e-cigarette products and e-cigarette harm reduction information for smokers can ensure that smokers make choices voluntarily according to their own values and preferences without any coercion and deception, which is the embodiment of respecting the rights of smokers.

The ethical framework of public health always emphasizes that the violation of individual rights and freedoms should be minimized to achieve public health goals. Even smokers who started 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 their own defined happiness, and we should show respect for smokers whether they decide to quit smoking or switch to e-cigarettes.” Rebecca Thomas of the University of Pittsburgh said she was also one of the authors of the paper.

“Concealing and distorting e-cigarette information

Public health institutions will lose credibility “

Since the individual rights of smokers should be respected, it is particularly important to provide accurate e-cigarette information to ensure that smokers make wise decisions.

“They (e-cigarette opponents) may say that it is safer to” let the public overestimate the risk of e-cigarette “, but concealing and distorting e-cigarette information will make public health institutions lose credibility. Once the credibility is lost, the public will question or even ignore other risk information released by the public, thus causing major public health hazards. “

Take the American lung disease reported by the media last year as an example. At that time, studies have confirmed that the cause of the incident was the use of black market cigarette oil illegally added with THC (tetrahydrocannabinol, a high concentration chemical substance extracted from industrial hemp), which has nothing to do with regular e-cigarettes. The CDC for Disease Control and prevention in the United States once ignored the research conclusions and attributed the cause of the disease to ordinary electronic cigarettes. It was not until March this year that the relevant information was corrected.

In the author’s opinion, this approach seems to protect consumers, but in fact, it does more harm than good: “it not only allows smokers who have already switched to e-cigarettes to smoke again, but also does not let everyone avoid the real culprit – black market thc products”.

The ethical framework of public health points out that the least restrictive interventions should be used to achieve public health goals. As far as the tobacco harm reduction goal is concerned, the restrictions on the provision of e-cigarettes for smokers are less than those for banning the sale of 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 to smokers can also provide cheaper harm reduction programs for vulnerable groups, reduce 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 large amount of evidence shows that e-cigarettes are much less harmful than cigarettes. Both the public health ethical framework and the biomedical ethical framework prove that the usability of e-cigarettes is ethical, which is a beneficial measure. Therefore, smokers should be encouraged to switch to e-cigarettes.” It is pointed out in the paper.

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