公共健康还是私人自由？

Sep 6, 2012 Peter Singer

普林斯顿—上个月出现了两起相反的判决。美国联邦上诉法院驳回了美国食品药品管理局关于香烟必须在印有健康警告图片的包装中销售的诉请，而澳大利亚最高法院的判决支持比美国激进得多的法律。根据澳大利亚的这项法律，烟草包装盒上不仅必须印上健康警告和吸烟引起的身体伤害的图片，而且包装本身必须非常简单，品牌名称需用小号通用字体印刷，不得带有商标图案，也不许用毫无生气的橄榄棕以外的颜色。

美国的裁决基础是美国宪法对言论自由的保护。法庭接受政府可以要求标上真实、正确的健康警告，但（微弱）多数意见认为不能到要求印上图像的程度。在澳大利亚，问题在于该法是否隐含着无条件征用——在这个案例中，是烟草公司对自身商标的知识产权。最高法院的裁决是没有。

但是，这些差异的背后是一个更大的问题：谁来决定公共健康和言论自由之间恰当的平衡？在美国，这由法院决定——从根本上说是通过如何解读有着225年历史的法律条文来决定——这会让政府可能减少香烟致死人数（最新数据表明每年有443000人）的方案受挫？也得执行。在澳大利亚，言论自由并没有宪法明文予以保护，法庭有更大的可能尊重民主选出的政府决定恰当平衡的权利。

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Peter Singer

Writing for PS since 2001
188 Commentaries

Peter Singer is Professor of Bioethics at Princeton University and founder of the non-profit organization The Life You Can Save. His books include Animal Liberation, Practical Ethics, The Ethics of What We Eat (with Jim Mason), Rethinking Life and Death, The Point of View of the Universe, co-authored with Katarzyna de Lazari-Radek, The Most Good You Can Do, Famine, Affluence, and Morality, One World Now, Ethics in the Real World, and Utilitarianism: A Very Short Introduction, also with Katarzyna de Lazari-Radek. In 2013, he was named the world's third "most influential contemporary thinker" by the Gottlieb Duttweiler Institute.

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Jack Schmidt Feb 3, 2015

Prof. Singer's argument is, basically, that the wolves are becoming better hunters, so we must put the deer herds in zoos. Prof. Singer, of course, is a zoo keeper, not a deer.
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Steve Barney Sep 18, 2012

Perhaps, if addition to tobacco were legally classified as a mental illness or treated like other drug additions, they could be forced to quit. You've probably heard of people committing petty crimes so they could get health care in jail or prision, and some of them may be people who are hopelessly addicted to cigarettes. That may be the only way that some people can quit smoking and save their lives. This is especially true in the case of the mentally ill, as you can see here, who (in the US) usually get less help with tobacco addiction than the rest of the population, and have much higher rates of addiction:

site:http://www.ctri.wisc.edu mentally ill - Google Search
http://www.google.com/search?q=site%3Ahttp%3A%2F%2Fwww.ctri.wisc.edu+mentally+ill&sourceid=ie7&rls=com.microsoft:en-us:IE-Address&ie=&oe=&rlz=
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Michael Lynch Sep 14, 2012

Like Mill I agree that individuals have the right to make their own choices but only in so much as they do not harm others. Smoking effects not just the person inhaling, but those around them, whether it be through second hand smoke or, like here in Canada, publicly funded health care. In that case we are all literally paying for the consequences (much like in the case of obesity outlined in Singer's article "Weigh More, Pay More"). It should be made clear that smoking isn't exclusively private.
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MK Anon Sep 10, 2012

This article here is the most biased I read from this author - whose views I usually appreciate. Actually, the underlying assumption is that smoking is bad (as is the case in the current DOGMA).

Just quoting a few things that bothered me the most:

"Underlying these differences, however, is the larger issue: who decides the proper balance between public health and freedom of expression?"
I think this is a secondary or even a tertiary question. As an ethicist, the first question should be what is the public health's domain, and where is there place for the public intervention. Smoking is a private choice with private consequences.. while non smoking is still a private choice, but with public consequences as they oppress non smokers. The only legitimate space for public intervention is to disclose information - not change people's behaviour and culture. Once information is given through massive campaign, it becomes an individual choice. Smoking also has been studied long enough to get good information - and is not comparable to new chemicals than first need to be studied to provide good information.

how about the validity of the argument that smoking was "imposed" by the companies producing cigarettes (i.e. a forced change of behavior like the one public health tyrans -PHT- are doing) ? I don't think so. One can notice that in all or many cultures, including those very closed to autarky, there has been some smoking in a way or another. In addition, nothing prevents the PHT to do the same kind of subtle advertisement - instead of using state's monopoly on violence.

As for the argument of death rate, it's an invalid measure of the "life cost" of different factors. It's better to use the years lost (adjusted for disability). Smoking related diseases occur later in life, while other factors have a different pattern, i.e. cars rather kill young poeple.. so for one teen of 18 "loosing" 50 years of expected life, there can be 50 poeple dying one year younger at the end of their life from smoking related diseases. In addition, if poeple have descreasing marginal utility of "life", the 18 years old case is much worse.

But the worse argument in the health cost in general. As everyone knows, cigartte's price is made of 90% taxes at least (when similar taxes on junk food?). Life-long smokers pay to the state somewhere close to 100k

Not only do they contribute more, but they also alleviate costs: first point is that everyone dies at some point and will "cosume" resources related to it's death.. be seated, you ll be shocked to hear that non-smokers have a very unhealthy death as well ! The non-smoker's colon cancer will be as costly as the the smoker's lung cancer. Cancer rate is more prevalent for smoker.. but it's really not cheaper to die from Parkinson, alzheimer or diabetes which are growing exponentially now. However, smokers die younger and therefore take less resources for the pension funds, or in other word, the ration of dependant population on active population is improved (in economic terms, I recall). And now they will die even younger from pneumonia since they have to go out of all places (which is also totally wrong: the market would pick the number of smoke-free to meet the demand).
So smoker contributes a lot more than others (tax differences), they consume less resources (die younger), and in addition, they are discriminated on the basis of their believes, individual identity, and group identity.

How fair is that, Mr the ethicist?

NB: I don't usually smoke and I am not related in any way with the tabacco industry
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Ismail OURAICH Sep 9, 2012

The most important aspect of the problematic, to the risk of sounding inhuman, is the fact that in all countries, no matter how advanced market economies they claim to be, health care services are subsidized by taxpayer money, i.e. there is not a pure market for healthcare where only the laws of supply and demand govern the price determination of the service, which then does not oblige us (i.e. taxpayers through elected representatives) to intervene to correct for the healthcare externality that stems from the disconnect between the profit-making motives of market institutions providing the service and the very public-good nature of healthcare services. Therefore, things as they are, we are effectively providing an incentive for the continuance of destructive consumerist behavior, in this case cigarettes consumption, by a fringe of society that hijacks basically the Constitutionally sanctioned principle of personal rights. I, personally, would have no qualms whatsoever with these people, no matter how irrational their behavior might seems to be, if they continue on their unhealthy habits of consumption if only if the cost of unintended consequences is lifted up of the shoulders of the rest of us. That is a very idealistic framework that did not, does not, and won't exist anytime soon. Given this, Society as a whole, thought elected officials, must have a say on the individual's health through meaningful policies that are enacted to limit the damage, and I do agree with the Australian approach that was given as an example.
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d clark Sep 9, 2012

The main problem, according to Singer, seems to be sophisticated deceptive subliminal advertising. His solution is to combat it face to face by legalizing scary text and image superliminal advertising.

If stealthy advertising that strikes below the conscious threshold is the problem, why combat it? Why not go after it, delegalize it, eliminate it completely?

It would be a long complicated haul, reaching far beyond the tobacco industry. But we've been complaining about this kind of deceit in advertising for a long long time. It is an unfair advantage that hurts consumers terribly. Is taking it on really impossible?
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