Tuesday, August 15, 2006

TODAYonline: Consider banning smoking outright

Consider banning smoking outright
Have laws against possession Set up addicts' centres

Letter from Goh Kian Huat
Letter from Robert W Straughan

I refer to the report, "Its promise distorted, Subutex fades on a low" (Aug 11).

Instead of curing heroin addiction, users are addicted to Subutex itself. So, Subutex has now been listed as a Class A Controlled Drug, with its distribution, consumption and possession (unless authorised) prohibited.

First- and second-time abusers arrested for Subutex consumption will undergo compulsory rehabilitation treatment, while recalcitrant abusers could face up to 13 years' imprisonment and 12 strokes of the cane. Traffickers face even stiffer penalties.

Wince...I feel sorry for the letter writers. I had a letter similarly conflated and truncated and it was deeply unsatisfying.

But back to the report on hand, anyone who has ever done any bit of debating for a fair amount of time would have come across at some point in time the arguments for the criminalisation of a particular action/vice/sin/social ill etc. And they basically boil down to the Harm Principle, the Black Market and why regulation is better than an outright ban.

But I want to take it from a separate perspective which I don't think is examined often enough in these types of debate.
Now consider this: Smoking is the single most avoidable cause of death. According to the Health Promotion Board, every cigarette contains over 4,000 types of chemicals, 400 of which are poisonous and about 40 are cancer-causing — for example, nicotine, carbon monoxide, tar, hydrogen cyanide. The nicotine is just as addictive as heroin or cocaine.

On a global scale, the World Health Organization estimates that tobacco kills one person every 10 seconds. Smoking is also a major risk factor for coronary heart disease, stroke and chronic obstructive lung disease, which together accounted for close to two-thirds of deaths here in 2000. Smoking harms those around the smoker also.

Yet, while cigarettes are as harmful as other commonly abused drugs such as heroin, cannabis, Ecstasy, ice and amphetamines, the Government has taken a softer approach by introducing laws to prohibit tobacco ads, restricting smoking in public places and imposing stiffer tobacco duties.

I think the numbers are about right, except I think that cannabis ought not to be in that category alongside the other drugs, the harm level associated with it is that much lower than the rest.

And the following logic is fairly impeccable...
It appears there is no neater plan to eradicate this problem than by banning smoking in Singapore. Since cigarettes are as harmful as Subutex and other abused drugs, I suggest the authorities consider laws to prohibit the possession and consumption of tobacco. Existing nicotine addicts may be given a grace period to seek help to quit.

It is good that the Government has taken steps to ban smoking in public places but, on the whole, its actions and intentions confuse me.

We all know underaged smoking (below 18), is illegal. The fact that the young may not be mature enough to make sound decisions regarding a damaging and activity underlies the ban. But smoking is just as damaging no matter what age the smoker.

No matter how harshly the Government discourages smoking, addicts will not be able to stop unless a full ban is implemented.

I suggest permitting smoking only at special centres, where rehabilitators help to cure smokers' addictions. There, smokers would be encouraged to stop but not forced.

Only then will we slowly be able to cure the disease of smoking in Singapore.

Or is it?

Well, the logic only works if you accept its premise i.e. that the government ought to intervene when the individual harms him or herself regardless of whether their actions hurt 3rd party i.e. the paternalistic approach that is the converse of the Harm Principle.

Because if one does not accept that premise, that the logic equally follows that since society is more than able to function with the "evils" of smoking, that drugs with similar levels of harm as enumerated above, should be legalised in the same fashion as smoking.

My personal opposition to smoking is in the harm it causes others in a direct fashion i.e. passive smoking and the fact that it's bloody annonying although if there was no direct harm, I might well change my mind on the current restrictions on smoking in public.

But let's go back to self-determination and bodily autonomy, and the question that we have to ask is on what basis does the government have to prevent self-abuse even till the point of death? One argument is that such actions do cause societal harm in that almost any form of drug abuse will lead to instances of higher medical care that is borne by society.

Two responses to that. One would be to make these people pay more which we already do through sin taxes so that they are not being subsidised by the other tax payers. The other is to question whether this is actually so. Apparently there is a study which has crunched the numbers and it comes to the startling conclusion that the state benefits from smokers dying young and not draining medical resources that are the province of the old and chronically infirm. A nasty state of affairs that.

Another argument is that the basis of all rights is life and without life one cannot enjoy those rights. Therefore, the government is justified in taking action that would prevent people from a course of action that would deprive themselves of those rights i.e. death. The most obvious rebuttal to that is that it may well apply to suicide but we all die anyway and smoking simply increases your risk of a disease that would kill you sooner than a healthy person would otherwise would. And similarly on that line of logic, we're going to have to ban fastfood and a whole bunch of other activities like skydiving (presumably on the basis that unlike driving, there is no societal utility from the others).

But the more fundamental problem is the argument is that it is simply a bald assertion and I should know that because I once used that argument to justify the torture of terrorists, nasty line of argument once you push it to its logical conclusion. It effectively justifies almost anything.

The positive argument in turn argues that the state is simply incapable of demonstrating a compelling interest to prevent their citizens from hurting themselves and might well point to the fact that the Common Law allows even the mentally insane to reject life-saving treatment as long as the person is aware of the consequences on the basis that only the patient is capable of determining what's in their best interest. This is of course part of a broader general proposition that only you know what you want and can determine what's in your own best interest as a rational thinking person.

This is of course not to say that the state is incapable of asserting some form of paternalism and limiting personal autonomy but those are generally on the basis that for some reason the rationality and thinking aspect of the equation has been diminshed or circumvented. Thus we limit the rights of children and do not allow suicide clubs or pacts for fear of undue influence. But it is nevertheless important to keep in mind that this is the exception to the rule and not the rule itself.

I come down on the side of personal autonomy and liberty because I'm simply not arrogant enough to impose my views on others and thus I "impose" (beware the fallacy of false equivocation) a system that would allow all views to promulgate.


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