Yvette van der Eijk

Development of an integrated tobacco endgame strategy

In recent years, various tobacco ‘endgame’ strategies have been suggested as a means to phase out tobacco consumption. Using country examples, this paper discusses three potential strategies: replacing cigarettes with alternative products (harm reduction), denying tobacco sales to people born after a certain year (the tobacco-free generation proposal), and further implementing measures based on the WHO Framework Convention for Tobacco Control (FCTC) treaty. It is argued that all strategies have potential issues that could be avoided by combining them into an integrated, sequential endgame that, first, using measures recommended in the WHO FCTC, creates a climate that facilitates the phasing out of cigarettes; second, implements a generational phase out of cigarette sales; and third, simultaneously permits the regulated use of alternative nicotine products. Thus, integrating ideas from various endgame strategies will result in a more effective, resilient tobacco endgame policy.

Human rights and ethical considerations for a tobacco-free generation

In recent years, a new tobacco ‘endgame’ has been proposed: the denial of tobacco sale to any citizen born after a certain year, thus creating new tobacco-free generations. The proposal would not directly affect current smokers, but would impose a restriction on potential future generations of smokers. This paper examines some key legal and ethical issues raised by this proposal, critically assessing how an obligation to protect human rights might limit or support a states ability to phase out tobacco.

Ethics of tobacco harm reduction from a liberal perspective

Mixed evidence on the possible harms, benefits and usage patterns of electronic nicotine delivery systems (ENDS, or ‘e-cigarettes’), has led to vigorous and ongoing debates on the issue. The ethical trade-off often represented is that, though smokers should be permitted access to ENDS as a less harmful alternative to smoking, this comes at the expense of non-smokers and children who may experiment with ENDS, become addicted to them, or experience health issues from long-term exposure to passive ENDS vapour. Lacking from many debates is a balanced analysis based on sound ethical reasoning, so this paper aims to examine the issue from a liberal perspective. More specifically, focus is on how ENDS policy can help to promote freedom in a broader sense, with ‘freedom’ considered as originating from having options and the necessary information and ability to autonomously choose between these options.

The Tobacco Industry, Researchers, and Ethical Access to UK Biobank: Using the Public Interest and Public Good

We have asked whether the strategic purpose of the tobacco industry is something that a public resource, such as UK Biobank, should support. Tobacco industry health research has been known to work irreconcilably with the purposes of such institutions, which can be surmised as for the public good and defined to improve the provision, diagnosis, and treatment of illness and the promotion of health throughout society. We have isolated possible conflicts of interest that underlie vested research agendas of the tobacco industry and that may extend to tobacco industry-funded researchers. With respect to research, we find that the tobacco industry is entirely at odds with the purposes of public biobanking.

Scientific and conceptual flaws of coercive treatment models in addiction

In conceptual debates on addiction, neurobiological research has been used to support the idea that addicted drug users lack control over their addiction-related actions. In some interpretations, this has led to coercive treatment models, in which, the purpose is to ‘restore’ control. However, neurobiological studies that go beyond what is typically presented in conceptual debates paint a different story. In particular, they indicate that though addiction has neurobiological manifestations that make the addictive behaviour difficult to control, it is possible for individuals to reverse these manifestations through their own efforts. Thus, addicted individuals should not be considered incapable of making choices voluntarily, simply on the basis that addiction has neurobiological manifestations, and coercive treatment models of addiction should be reconsidered in this respect.

A Blurry Line Between Metaphysical Free Will and Autonomy in Addiction

actual initial factors most of us would consider necessary to make an autonomous decision. We can easily imagine an analogous scenario, albeit with a normal adult like Jimmy, who offers an entirely different reason than his original one (i.e., fear born out of a perceived elevated risk of death) for opting for immediate treatment. He claims and genuinely believes that he chose surgery because it would be cheaper than annual checkups and potential treatment for more advanced cancer in the long run. Under the model of basic autonomy that Dubljević proposes, decisions that are vulnerable to this same switch would be considered free anyway by virtue of valid post hoc rationalization. But how can we hold people responsible for their behavior if they are not aware of the true motivations behind their actions? Dubljević’s definition of autonomy cannot account for this flaw. Dubljević is correct to imply that complete autonomy only exists in a vacuum and that this ideal has no place in practical philosophy. His proposed form of autonomy, however, rests on the assumption that individuals are willing players in a social and political world. It is reasonable to accept that individuals understand this reality to a greater or lesser extent. But individuals possess the capacity to weigh the influences of external and internal factors only if they are consciously aware of them. In the case of Jimmy, he may face overt pressure from his wife to choose active surveillance. He can consider her thoughts and make a choice independently with the full knowledge that his wife has a great interest in preserving his normal urinary, bowel, and sexual functions. By contrast, Jimmy cannot assess his doctor’s persuasive maneuvers without knowing they are there at all. The error in Dubljević’s framework of autonomy is that any choice that can be backed by good reasons could ipso facto be deemed “autonomous” with little regard for the original intent. Healthy adults all possess the capacity to reason, but this alone is insufficient. They must actively exercise this capacity before they act in order for it to give rise to any meaningful notion of autonomy. Though we may never be able to determine whether free will is an illusion, we can most certainly conclude that post hoc autonomy is.

E‐cigarette use in pregnancy: a human rights‐based approach to policy and practice

The health risks associated with e‐cigarette use in pregnancy are mostly unknown. Guidelines by the World Health Organization and national health agencies warn women against using e‐cigarettes in pregnancy; however, in the UK, a recent multiagency guideline takes a different approach by not discouraging e‐cigarette use in pregnancy. Furthermore, e‐Voke™, an e‐cigarette, has been approved for use in pregnancy in the UK. We analyze United Nations human rights treaties to examine how they might inform best practice recommendations for e‐cigarette use in pregnancy. These treaties oblige Parties to adopt policies that protect childrens and womens right to health, appropriate pregnancy services, and health education. We argue that clinical practice guidelines related to use of e‐cigarettes in pregnancy should consider both evidence and human rights principles, and ensure that healthcare providers and patients are given clear, accurate messages about the known and potential risks associated with e‐cigarette use in pregnancy.

Ethical issues in the treatment of addiction

Addiction or dependence to a psychoactive substance – or drug – is a biopsychosocial disorder. Many aspects of addiction can be clinically treated, yet this raises some important ethical issues. The health and social problems resulting from addiction are generally influenced by sociopolitical agendas and prevailing views about addiction, and therefore, we make some brief observations about how these affect the act, manner, or method of treating someone who is addicted. In this chapter, we focus on some recent developments in the treatment of addiction: pharmacological approaches, and invasive brain therapies. In addition to giving an ethical overview of these, we look more generally at the justification for coerced treatment.

Tobacco: Prohibition, Coffee Shops, or Discouragement?

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The Tobacco Industry and Children’s Rights

Using previously secret tobacco industry documents, we show how tobacco companies formed partnerships with UNICEF to undermine UNICEF’s involvement in tobacco control. The manufacture, use, and marketing of tobacco present a serious threat to children’s right to health. This makes the Convention on the Rights of the Child a potentially powerful tobacco-control tool and the United Nations Children’s Fund (UNICEF), which oversees the convention’s implementation, a potential leader in tobacco control. UNICEF actively supported tobacco control initiatives in the late 1990s, but since the early 2000s UNICEF’s role in tobacco control has been minimal. Using the Truth Tobacco Industry Documents library, an online collection of previously secret tobacco industry documents, we sought to uncover information on the tobacco industry’s ties with UNICEF. We found that from 1997 to 2000, when UNICEF was actively promoting tobacco control to support children’s rights, the tobacco industry saw children’s rights and UNICEF as potentially powerful threats to business that needed to be closely monitored and neutralized. The industry then positioned itself as a partner with UNICEF on youth smoking prevention initiatives as a way to avoid meaningful tobacco control measures that could save children’s lives. After UNICEF’s corporate engagement guidelines were loosened in 2003, tobacco companies successfully engaged with UNICEF directly and via front groups, including the Eliminating Child Labour in Tobacco Growing Foundation. This was part of an overall tobacco industry strategy to improve its corporate image, infiltrate the United Nations, and weaken global tobacco-control efforts. As part of its mission to protect children’s rights, UNICEF should end all partnerships with the tobacco industry and its front groups.