. "PART II A BLUEPRINT FOR REDUCING TOBACCO USE, 4 Reducing Tobacco Use: A Policy Framework." Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press, 2007.
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Ending the Tobacco Problem: A Blueprint for the Nation
liberty-enhancing effects (achieved by assisting addicted smokers to quit) and liberty-restricting effects (insofar as they also “burden” the choices of smokers who do not want to quit or who object to the restrictions or costs imposed on them). Thus ethical analysis of tobacco control interventions within the libertarian paradigm requires a weighing of the liberty-reducing effects of particular intervention against the liberty-enhancing effects of these interventions for nonsmokers whose freedom to avoid ETS exposure is protected, for youths whose long-run autonomy is preserved, and for adult smokers whose ability to quit is enhanced (and who therefore regard the intervention as a benefit rather than a cost).
Even within these boundaries, however, burdens on individual smokers that are intrusive or coercive do require heightened justification. The more restrictive the intervention (and, consequently, the greater the burden on smokers’ freedom) the stronger the case must be that the intervention protects youths or nonsmokers or helps smokers quit. That important principle is embraced by the committee in its evaluation of each of the tobacco control interventions considered in the following chapters.
AN ASIDE ON THE PATERNALISM PROBLEM
It can also be argued that paternalism in this context is a justified response to irremediable deficiencies in smokers’ capacity to successfully exercise self-interested decision-making about whether they should continue to smoke. Although the committee’s blueprint need not rest on this argument, many committee members do find elements of it convincing, and that is why we summarize it here.
The argument runs as follows: (1) virtually all addicted adults begin smoking (and probably become addicted) while they are adolescents before they have developed the capacity to exercise mature judgment about whether or not to become a smoker; (2) the preferences expressed when people begin to smoke, which tend to ignore long-term health risks, are inconsistent with the health-oriented preferences they later come to have, and they soon regret the decision to have become a smoker; and (3) once smokers begin to be concerned about the health dangers of smoking, their judgment is often distorted by optimism bias (“the harms will happen to other people, not to me”), thereby weakening their motivation to quit.
As shown in Chapter 2, between 80–90 percent of smokers start smoking before they turn 18 years of age. When they begin to smoke, they typically lack a full and vivid appreciation of the consequences of smoking and the grip of addiction, even if they have a roughly accurate understanding of