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The Language of Freedom in Public Health: the Case of the Smoking Ban

Alberto Giubilini

 

Enough manipulation of the definition of man, and freedom can be made to mean whatever the manipulator wishes

(Isaiah Berlin, Two Concepts of Liberty, 1958)

 

The UK Prime Minister has announced his plan to ban the sale of tobacco products to young generations in England. Smoking will be phased out by progressively increasing the legal age for buying tobacco every year. Assuming the plan is effective and does not simply open the door to a black market, young generations in England will be prevented from starting to smoke. According to the Prime Minister, “this measure will be the single biggest intervention in public health in a generation.”

It is hardly necessary to provide figures about the risks of smoking. Lighting up that first cigarette is one of the most unhealthy choices one could ever make. In fact, it is a decision many regret later in life. The question is: to what extent is a government justified in preventing competent individuals from making unhealthy decisions for themselves?

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Banning Cigarettes, Paternalism, Liberty and Harm: Clearing the Smoke

Media headlines in the UK are widely reporting Rishi Sunak’s announcement of a proposal to ban smoking for younger generations. Under the proposal, the legal age of smoking would increase by one year every year so that, eventually, no-one would be able to buy tobacco.

The proposal has proved to be controversial, and it has prompted a number of different arguments. This is unsurprising; the proposal represents a classic conflict between individual well-being, liberty, and third-party interests. As the BBC reports, some commentators have also highlighted an apparent inconsistency in Sunak’s own position, since he recently pushed back part of the government’s anti-obesity strategy, because of “people’s right to choose”. Again, the BBC reports that Sunak’s own response to this consistency argument has been that there is an important difference between the two policy positions, because ‘there is no healthy level of smoking’, whilst one can enjoy unhealthy foods as part of a healthy diet.

However, the claim that there is ‘no healthy level of smoking’ can be used to respond to this consistency argument and support the proposed smoking ban in quite different ways. Whether we support or oppose the proposal, it is crucial to be clear about the precise moral arguments that both supporters and opponents are making.

One useful way to begin is by thinking about whether or not the proposed ban is paternalistic.

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Healthcare Allocation for Limited Budgets

By Joshua Parker and Ben Davies

Like many public services, the UK’s National Health Service (NHS) is under increasing resource pressure across the service. Acute services are under strain, with every stage between dialling 999 and getting into a hospital bed taking longer. Waiting times are also up for non-urgent care: 7 million people are on a waiting list in England, while General Practitioners (GPs, the UK’s primary care physicians) are exceeding safety limits and still not managing to meet demand. These measures are only proxies; the underlying concern is that failures in these metrics betray failures of quality and safety.

In part this is due to chronic under-investment made worse by a range of factors: greater demand generated by Covid and lockdowns; increasing complexity with an ageing patient population; more medical ability due to developments in medical technologies; and staff shortages that are in part a result of the UK’s departure from the European Union. However, some may argue that the pressure is also a sign that the NHS is trying to do too much in straitened times, and perhaps even that the scope of what a health system is responsible for has been expanded too far.

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Honesty and Public Health Communication: Part 2

Written by Rebecca Brown

This post is based on two recently accepted articles: Brown and de Barra ‘A Taxonomy of Non-Honesty in Public Health Communication’, and de Barra and Brown ‘Public Health Communication Should be More Transparent’.

In a previous post, I discussed some of the requirements for public health institutions to count as ‘honest’. I now want to follow that up to discuss some of the ways in which public health communication seems to fall short of honesty.Read More »Honesty and Public Health Communication: Part 2

Guest Post: Body Shaming is Unacceptable, Even if Directed at Vile People. An Intersex Critique of “Small Dick Energy” 

Guest post by Morgan Carpenter, bioethicist; co-founder and executive director, Intersex Human Rights Australia; Magda Rakita co-founder and executive director, Fundacja Interakcja (Poland), and co-chair, OII Europe; and Bo Laurent, founder, Intersex Society of North America

We love Greta Thunberg. But we were hurt and disappointed that she chose “small dick energy” as a pejorative in her recent Twitter exchange with the self-proclaimed “misogynist influencer” Andrew Tate. This particular choice of words was not, in our view, the self-evidently praiseworthy retort that many progressive commentators took it to be.

Don’t get us wrong. Rhetorically taking someone down a notch is undoubtedly sometimes appropriate. Especially if they have an inflated ego, an objectionable moral character, and regularly disrespect others, as appears to be the case with Tate.

We aren’t against mocking misogynists.

But we are against doing so by alluding to, or making disparaging comments about, body parts or mental attributes possessed by marginalized people — people who suffer unjust stigma due to those very traits.Read More »Guest Post: Body Shaming is Unacceptable, Even if Directed at Vile People. An Intersex Critique of “Small Dick Energy” 

Abortion in Wonderland

By Charles Foster

 

 

Image: Heidi Crowter: Copyright Don’t Screen Us Out

Scene: A pub in central London

John: They did something worthwhile there today, for once, didn’t they? [He motions towards the Houses of Parliament]

Jane: What was that?

John: Didn’t you hear? They’ve passed a law saying that a woman can abort a child up to term if the child turns out to have red hair.

Jane: But I’ve got red hair!

John: So what? The law is about the fetus. It has nothing whatever to do with people who are actually born.

Jane: Eh?

That’s the gist of the Court of Appeal’s recent decision in the case of Aidan Lea-Wilson and Heidi Crowter (now married and known as Heidi Carter). Read More »Abortion in Wonderland

The Homeric Power of Advance Directives

By Charles Foster

[Image: Ulysses and the Sirens: John William Waterhouse, 1891: National Gallery of Victoria, Melbourne]

We shouldn’t underestimate Homer’s hold on us. Whether or not we’ve ever read him, he created many of our ruling memes.

I don’t think it’s fanciful (though it might be ambitious) to suggest that he, and the whole heroic ethos, are partly responsible for our uncritical adoption of a model of autonomy which doesn’t do justice to the sort of creatures we really are. That’s a big claim. I can’t justify it here. But one manifestation of that adoption is our exaggerated respect for advance directives – declarations made when one is capacitous about how one would like to be treated if incapacitous, and which are binding if incapacity supervenes if (in English law) the declaration is ‘valid and applicable.’ 1.

I suspect that some of this respect comes from the earliest and most colourful advance directive story ever: Odysseus and the Sirens.Read More »The Homeric Power of Advance Directives

Healthcare Ethics Has a Gap…

By Ben Davies

Last month, the UK’s Guardian newspaper reported on a healthcare crisis in the country. If you live in the UK, you may have already had an inkling of this crisis from personal experience. But if you don’t live here, and particularly if you are professionally involved in philosophical ethics, see if you can guess: what is the latest crisis to engulf the publicly funded National Health Service (NHS)?

Read More »Healthcare Ethics Has a Gap…