Nuances in the ethical regulation of electronic nicotine delivery systems

Abstract

We thank the commentators for their thoughtful reflections on our article.Billie Bonevksi [1] makes a strong case for giving greater weight to equity in regulating ENDS.Equity is an increasingly important ethical value in this debate because cigarette smoking is now concentrated among the most disadvantaged citizens in developed countries where cigarette smoking has been substantially reduced by increasing taxes, banning advertising and implementing smoke free policies. She argues that it is still too early to say if ENDS will realise the health benefits for low SES smokers claimed by their proponents. We agree there needs to be more investigation of their value and some form of regulated access to ENDS is the best way of allowing this to be done.Lyn Kozlowski [2] illustrates the ways in which moral biases have truncated ethical analyses of tobacco harm reduction (THR) policies. He reminds us that moral reasoning often involves a motivated search for reasons to justify pre-existing beliefs, as has occurred on both sides of the polarised debate about THR. Each side is convinced of the justice and cogency of its cause which it supports by the selective citation of equivocal evidence. Each is exasperated by what they see as their opponents' failure to appreciate the strength of their arguments. This creates a readiness to impute the worst motives to those with whom they disagree (e.g. that advocates of ENDS are in the pay of the tobacco industry or that opponents of ENDS hate smokers).

Ethical issues for e-cigarette control policies in Australia

“…Away from the clinical debates around effectiveness, it has also been argued that use of nicotine-containing e-cigarettes as an option makes smoking cessation messages confusing for the public (9,24). The public might possibly interpret it as evidence for a safe level of smoking.…”

Differential access to health care and support? A qualitative analysis of how Australian smokers conceptualise and respond to stigma

“…With emerging discussions about the ethics of regulating these products (e.g. Hall et al, 2015a;Hall, Gartner, & Forlini, 2015b), it also begs the question of extending these debates to the ethics of stigmatising e-cigarettes and their users through policy and public health campaigns. For instance Williamson, Thom, Stimson, and Uhl (2014) argued that stigma-induced approaches and policy adopted to address tobacco use should not automatically be extended to e-cigarettes given that these two products have vastly different risks and benefits to the user.…”

Truth Telling about Tobacco and Nicotine

“…In one area, however, the contours of debate are less clear. Abrams et al, for example, give prominence to the need for “accurate public information” [6], a theme that is echoed in other harm reduction-oriented publications with repeated calls for more “candid” public communication, and condemnation of “misleading risk communications” [8,9,10,11]. In line with this theme, evidence suggests that many people, including tobacco control professionals, misperceive the relative health risks of non-combustible products such as e-cigarettes, snus and nicotine replacement therapies, particularly as compared to combustibles, and over attribute the health harms of tobacco and nicotine products to the presence of nicotine alone [9,12,13,14,15,16].…”