Ethical dilemmas and human rights considerations arising from the evaluation of a smoking policy in a health promoting setting

Abstract

One of the key challenges in managing the Health Promoting Workplace is the development of an effective policy for the control of environmental tobacco smoke (ETS). This paper explores the ethical consequences raised when the implementation of such a policy was evaluated in a large multi-campus university. In a three-stage evaluation, the first stage involved a qualitative enquiry with the Health and Safety Committee to obtain the management perspective on the working of the policy. A survey of the perception of the ETS policy and smoking behaviours with a representative sample of staff and students constituted the second stage. In the final stage the Health and Safety Committee was engaged with the findings of stages 1 and 2 to develop a response to the evaluation. The ethical implications which arise from this evaluation centre, firstly, on the underlying reasons for undertaking an evaluation. Secondly, consideration is given to the consequences of applying utilitarian principles to smoking policy for the minority who smoke and thus find their work or study patterns affected by a smoking ban. Such a ban limits their autonomy and while it may be helpful (beneficent) in terms of their longer-term physical health, it may have harmful (maleficent) effects on their psychological wellbeing and the potential for negative consequences if they choose to contravene the ban on smoking. The implications of addressing this situation are explored.

Reducing social inequities in health through settings-related interventions — a conceptual framework

“…Among the documents we reviewed, we found initiatives that focused on health issues (20)(21)(22)(23)(24)(25)(26)(27), and others that strove to improve the social conditions of people in a setting (16,. The majority of initiatives directly targeted marginalized areas, schools or workplaces (16,(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(32)(33)(34)(35)38,40,42,(44)(45)(46)(48)(49)(50)(51)(52)(53)(54), while fewer interventions focused on whole populations found in settings that were not necessarily deprived, as seen with Healthy Cities initiatives (31,36,37,39,41,43,45,47). Programs included action at multiple levels of a setting (from the individual to structural dimensions) (16,…”

Privacy and Ethics in Pediatric Environmental Health Research—Part I: Genetic and Prenatal Testing

“…Collection of maternal urine samples or amniotic fluid to identify toxicants that may be associated with congenital anomalies may uncover maternal use of illicit drugs or illegal use of prescription drugs that can lead to criminal investigation, a child welfare complaint, loss of food stamps, or loss of Supplemental Security Income. Identification of toxicants in biologic samples from the mother or infant may also lead to disqualifications regarding maternal employment opportunities, social stigma, legal risk, or self-recrimination ( Harvey et al 2002 ). For example, Grandjean and Sorsa (1996) describe an instance in which a manufacturing company excluded smokers from work sites with asbestos exposure because of data indicating smoking might increase susceptibility to asbestos-related lung cancer.…”

Measuring tobacco smoke exposure: quantifying nicotine/cotinine concentration in biological samples by colorimetry, chromatography and immunoassay methods

“…A large body of evidence indicates that tobacco smoking has unfavorable consequences on human health [1][2][3][4][5][6][7]. Chronic smokers run the risk of lung cancer [2,[8][9][10][11][12][13][14][15][16][17], respiratory infections [18,19], heart disease [2,[20][21][22], and pregnancy complications [23,24] caused by inhalation of nicotine, the principal component of tobacco.…”