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lies in the enormous social costs attributable to tobacco-related disease; reducing tobacco use increases overall population health. Further, even within a libertarian paradigm, each of the subsidiary goals of tobacco policy is clearly justified: reducing exposure to ETS prevents harm to nonsmokers; preventing initiation by youth is justified by the recognized shortcomings of adolescent judgment; and promoting cessation helps to restore the liberty of smokers who are able to quit. Ethically speaking, the most controversial interventions are those aimed exclusively at reducing use by the minority of adult smokers who do not want to quit. This is the nub of the so-called paternalism problem.

However, since every intervention aimed at current smokers serves the interests and express wishes of the subset who want to quit, interventions designed to protect the health of adult smokers do not necessarily rest on a paternalistic foundation. Instead, they entail both 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 object to the restrictions and costs imposed on them). Thus ethical analysis of tobacco control interventions within the libertarian paradigm requires a weighing of liberty-reducing effects of particular intervention against the liberty-enhancing effects of these interventions for nonsmokers whose freedom to avoid ETS exposure is protected, youths whose long-run autonomy is preserved, and adult smokers whose ability to quit is enhanced (and therefore regard the intervention as a benefit rather than a cost). This problem is addressed further in Chapter 4.

Limits of the Charge

Reducing tobacco use is, of course, a global challenge. According to a recent World Health Organization (WHO) study, tobacco-related diseases will kill 6.4 million people a year by 2015, accounting for 10 percent of all deaths worldwide. There are now many millions of smokers in the world, served by increasingly aggressive transnational tobacco companies. The common interest of all nations in reducing tobacco use has been declared and effectuated by the WHO-sponsored Framework Convention for Tobacco Control, which went into effect in 2005 and has been ratified by 142 nations (unfortunately not including the United States). The United States has a direct stake in reducing smuggling of tobacco products into this country that could undermine domestic tobacco control efforts, and the committee also recognizes the compelling importance of international tobacco control efforts for world health. However, the committee’s charge was to develop a tobacco control blueprint for the nation, not for the world. We hope, though, that some of the measures recommended in this report will provide useful models for other countries, just as the domestic



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