Ethical Considerations in the Prevention of Smoking in Adults and Children

Christoffel T. Stein S. , Using the Law to Protect Health: The Frustrating Case of Smoking, Medicolegal News 7(4): 5–9, 33, 28 (Winter 1979).

Matthews D. B. , Where There's Smoke There's Ire, Medicolegal News 7(4): 4, 19 (Winter 1979).

Luce B. R. , and Schweitzer S. O. , Smoking and Alcohol Abuse: A Comparison of their Economic Consequences, New England Journal of Medicine 298(10): 569–71 (March 1978).

Estimates of the shortening of life by regular smoking have been made by Lader M. , Nicotine and Smoking Behaviour, British Journal of Clinical Pharmacology 5: 289–92 (1978), by the Royal College of Physicians of London in Smoking or Health (Pitman Medical, London) (1977), and by Ouellet B.L. Romeder J.M. Lance J-M. , Premature Mortality Attributable to Smoking and Hazardous Drinking in Canada, American Journal of Epidemiology 109(4): 451–63 (1979). Only the second of these is equivalent to a lower average shortening of life than the value used here.

Thompson M.E. , Statistics of Smoking in Canada (Health and Welfare Canada, Ottawa) (1978). Also Smoking Habits of Canadians: 1977 (Health and Welfare Canada, Ottawa) (1979).

Population: Demographic Characteristics (Catalogue 92–832: Statistics Canada, Ottawa) (1978).

Assuming that, based on previously cited sources, historically 45 percent of men and 20 percent of women in Canada smoked more than 10 cigarettes a day, thereby reducing their lifespans by an average of five years, it can be estimated that the retirement age population in any year would have been reduced by 14.8 percent in the case of males and by 6.4 percent in the case of females, from smoking alone, the overall average reduction being 10.3 percent.

This is my estimate, based on the estimated average gross national expenditure per person for all persons in Canada for that year, noting that older people tend to have less actual cash income but more in the way of government benefits and usable capital resources — see Perspective Canada II (Statistics Canada, Ottawa) (1977). It should be noted that the fact that a person may have saved for his or her old age, rather than live explicitly off the community, is irrelevant to my argument. Older people who are not producing, i.e., the vast majority, are consuming resources that could be used by others. In strict economic terms they are a cost to society. An economist might argue that, if rigorous economic principles are to be followed, the marginal cost of an older person should be employed, not the average cost. There seem to be no data relevant to estimating the marginal cost, and therefore an estimate of average cost must suffice. All monetary estimates in this paper are given in Canadian dollars, which, in 1976, were worth approximately the same as U.S. dollars.

Shillington E.R. , Selected Economic Consequences of Cigarette Smoking (Health and Welfare Canada, Ottawa) (1977). The adjusted figure is based on the difference by a factor of 10 of the populations of the U.S. (217,871,000) and Canada (23,442,000). Hammond Almanac of a Million Facts (Hammond Almanacs, Maplewood, N.J.) (1979).

Daly H.E. , Steady–State Economics (W.H. Freeman, San Francisco) (1977).

Solomon L. , The Conserver Solution (Doubleday, Toronto) (1978).

Bowley A.L. , Alcohol: Social and Economic Aspects (Gollancz, London) (1931).

Smoking and Health — A Report of the Surgeon General (DHEW, Public Health Service, Washington, D.C.) (1979).

Brown S.M. , Effect on Mortality of 1974 Fuel Crisis, Nature 257:306–07 (September 1975).

Statistical Abstract of the United States (U.S. Department of Commerce, Washington, D.C.) (1978).

Bass F. , A Public Health Approach to Unhealthy Behavior: The Example of Tuberculosis Control Applied to Cigarette Smoking. In Somers A.R. , (Ed.), Promoting Health: Consumer Education and National Policy (Aspen Systems Corp., Germantown, Md.) (1976).

Agar K. Letter to Toronto Star, October 24, 1979.

See Daly, H.E., Steady–State Economics, note 10 supra.

Bewley B.R. Bland J.M. , Smoking and Respiratory Symptoms in Two Groups of Schoolchildren, Preventive Medicine 5:63–69 (1976). Rush D. , Respiratory Symptoms in a Group of American Secondary School Students: The Overwhelming Association with Cigarette Smoking, International Journal of Epidemiology 3(2): 153–65 (1974).

Rantakallio P. Relationship of Maternal Smoking to Morbidity and Mortality of the Child up to the Age of Five, Acta Paediatrica Scandinavica 67:621–31 (1978). Tager I.B. , Effect of Parental Cigarette Smoking on the Pulmonary Function of Children, American Journal of Epidemiology 110(1): 15–26 (1979).

Rush D. Changes in Respiratory Symptoms Related to Smoking in a Teenage Population: The Results of Two Linked Surveys Separated by One Year, International Journal of Epidemiology 5(5): 173–78 (1976).

Harrison G.N. , Peripheral Airway Function in Healthy Young Cigarette Smokers, Lung 156(3): 205–15 (1979). Niewoehner D.E. Kleinerman J. , and Rice D.B. , Pathologic Changes in the Peripheral Airways of Young Cigarette Smokers, New England Journal of Medicine 291(15): 755–58 (1974). Seely J.E. Zuskin E. , and Bouhuys A. , Cigarette Smoking: Objective Evidence for Lung Damage in Teenagers, Science 172:741–43 (May 1971).

McKennell A.C. , and Thomas R.K. , Adults and Adolescents Smoking Habits and Attitudes (Her Majesty's Stationery Office, London) (1977).

See Thompson M. E. , note 5 supra.

See, note 13 supra, page 2–21.

Aspects of this matter were examined in some detail by Wilkinson D.A. in his presentation entitled, Legal, Ethical, and Practical Problems with Legal Regulation of Licit Drug Use by Children, made to the international conference on Legal and Ethical Aspects of Health Care for Children, Toronto, October 1979, sponsored in part by the American Society of Law and Medicine.

See, note 13 supra. The quotations are from pages 17, 17–19, and 20–24.

See, note 13 supra, page A17, and Thompson M.E. , note 5 supra. The most recently available data suggest that in the United States this may be true only for 17–year–old women. Harris J.E. , in a draft of his chapter for the 1980 Surgeon General's report on Smoking and Health, entitled Cigarette Smoking Among Women and Men in the United States, 1900–1979, notes that according to preliminary results of a survey conducted by the National Institute of Education during late 1978 and early 1979, 26.2 percent of female 17–18 year–olds and 19.2 percent of male 17–18 year–olds smoke regularly. Comparable figures for 1974 were 25.9 percent and 31.0 percent respectively.

Ward S. , Television Advertising and the Adolescent, Clinical Pediatrics 10(8): 462–64 (August 1971).

Whiteside T. , Smoking Still, New Yorker 50: 121 (November 19, 1974).

Wynder E.L. Hoffman D. , Smoking and Health: Pathogenic and Preventive Considerations, Bulletin der Schweizerischen Akademie der Medizinischen Wissenschaften 35:83–98 (March 1979).

Shute R.E. , Initiation of Information–Based Programming for Smoking Education in Elementary Schools, Unpublished report to the American Cancer Society, 1979.

Massam A. , Babies Are Fascinated as Their Parents Light Up, The Journal (Addiction Research Foundation, Toronto) (March 1980).

Bewley B. R. Johnson M.R.D. Banks M.H. , Teachers' Smoking, Journal of Epidemiology and Community Health 33:219 (1978).

Criminal Code of Canada, § 166.

More than discomfort is involved. A recent study of the effects of long–term passive smoking shows the effects approximately equal to those of light smokers. Small–airways function was significantly reduced and chronic exposure to tobacco smoke in the work environment was concluded to be deleterious to the nonsmoker. White J.R. Froeb H.F. , Small–Airways Dysfunction in Nonsmokers Chronically Exposed to Tobacco Smoke, New England Journal of Medicine 302(13): 720–23 (March 1980).

Gilbert R.M. , Attitudes Towards Smoking in Public Places (Survey conducted by Ahsan A. Chhabra R. , and Nassar N. ) Unpublished report to Health and Welfare Canada (1977).

Minutes of the Council of the City of Toronto, 1975–1980.