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“E-cigarette availability” is a group intervention to encourage smokers to switch to e-cigarettes. It has two meanings: to make it clear to smokers that e-cigarettes are less harmful than cigarettes, and to ensure that they can easily obtain e-cigarettes.
The author of the paper pointed 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 health decisions on their own, in line with the principle of respect for individual rights and autonomy, and promote social fairness and justice. At the same time, the use of “e-cigarette availability” to achieve public health goals is less restrictive than traditional tobacco control practices.
The biomedical ethics framework has proposed four principles, namely respect for autonomy, benevolence (increasing the welfare of patients), non-maliciousness (avoid harming patients), and justice. E-cigarettes are far less harmful than cigarettes, and allowing smokers to switch to e-cigarettes can help smokers avoid the harm caused by traditional tobacco, thus conforming to the principles of benevolence and non-maliciousness.
More importantly, this program also fully meets the ethical needs of respecting the principle of autonomy.
Respect for autonomy means to respect 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 voluntary choices based on their own values and preferences without any coercion and deception. This is a manifestation of respect for the rights of smokers.
The public health ethics framework always emphasizes that the realization of public health goals should minimize violations of individual rights and freedoms. Even smokers who start to quit smoking in their old age 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 definition of happiness. Regardless of whether a smoker decides 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.
Since the personal rights of smokers should be respected, it is particularly important to provide accurate e-cigarette information to ensure that smokers make wise decisions.
Take the American lung disease reported by the media last year as an example. At that time, research confirmed that the cause of this incident was the use of black market smoke that was illegally added with THC (tetrahydrocannabinol, a high-concentration chemical extracted from industrial hemp). Oil has nothing to do with regular electronic cigarettes. The CDC US Centers for Disease Control and Prevention once ignored the research conclusions and attributed the cause of the disease to ordinary e-cigarettes, and 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: “Not only does it allow smokers who have switched to e-cigarettes to re-smoker, it also does not allow everyone to avoid the real culprit-black market THC products.”
The public health ethics framework states that to achieve public health goals, the least restrictive interventions should be used. As far as the goal of tobacco harm reduction is concerned, the restrictions on the provision of e-cigarettes for smokers are less than the ban on the sale of e-cigarettes and all tobacco products, so it meets their ethical needs.
In addition, providing smokers with e-cigarette products and e-cigarette harm reduction information can also provide cheaper harm reduction programs for disadvantaged groups, reduce social health gaps, and promote social justice.
According to data from the World Health Organization, tobacco causes more than 8 million deaths each 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 ethics framework and the 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.
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