Ethical issues for e-cigarette control policies in Australia

Australia has seen a sustained decrease in smoking for many decades by implementing a comprehensive multi-level tobacco control strategy . The proportion of Australians who smoke tobacco daily has decreased from 24% in 1991 to 12.2% in 2016, and 11.0% in 2019 . However, it is seen that proportion of Australians who have ever used electronic cigarettes (e-cigarettes) has increased from 8.8% in 2016 to 11.3% in 2019. The policy and regulatory space around e-cigarette is currently evolving in Australia, even amidst the Covid-19 pandemic.

Policy critique and analysis of evidence on e-cigarettes is substantial, but analysis of the ethical issues in Australia is scant. Previous analysis of ethical issues control e-cigarettes in Australia has been either based on principlism (the ethical principles of autonomy, beneficence, non-maleficence, and justice) or through the prism of harm reduction. Principlism is not well suited to analysing ethical issues around public health policies. Public health decision making is inherently more complex, involves larger numbers of stakeholders with different value systems, and is contextual in nature. Harm reduction, though a key tenet to guide e-cigarette policies, has its roots in libertarianism, a value system which might fundamentally not align with the moral beliefs of many stakeholders. As such, using a single philosophical lens for analysing public policy is not desirable.

This article analyses ethical issues around all aspects of e-cigarette control in Australia using a three-step public health ethics framework . The three-step framework does not presume superiority of any set of moral norms over another and helps clarify ethical issues contextually and comprehensively. The approach in brief consists of analysing ethics and contexts around the issue at hand, analysing ethical dimensions of alternative courses of action and a final stage of justification for a particular public health decision. The need for a comprehensive policy framework to tackle e-cigarette use has been identified, and as such, an ethical analysis of all aspects of control is necessary. To ensure comprehensive coverage of e-cigarette control policies, the ethical analysis is structured within the World Health Organization’s WHO-MPOWER framework of tobacco control. The WHO-MPOWER (Monitor tobacco use and prevention policies, Protect people from tobacco smoke, Offer help to quit tobacco use, Warn about the dangers of tobacco, Enforce bans on tobacco advertising, promotion and sponsorship, Raise taxes on tobacco) is a comprehensive framework to monitor implementation of control policies . To the best of my knowledge, such a comprehensive approach for understanding ethical issues around e-cigarette control policies has not been undertaken globally.

Read the full article published in Indian J Med Ethics here (open access)

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