Choice, liberty and the evil weed
Smoking is not a cause - but anti-smoking has become a crusade.
It’s the kind of headline that you assume that you must have misread: ‘Smoking ban “may harm patients”‘. Accustomed as we are to reading headline after headline reporting calls for bans on smoking in pubs and restaurants, a headline that reports some objections to smoking bans in hospitals seems nothing but perverse.
But you haven’t misread the headline, and the story is not a put-up job by cranks, pro-smokers and Big Tobacco. It is a humane response by UK health professionals, including the Royal College of Nursing (RCN) and the mental health charity SANE, to a government proposal to outlaw smoking in all NHS buildings and grounds by the end of 2006.
The RCN has pointed out that such an initiative must be ‘practical, flexible as well as desirable’, using policies that ‘support and not stigmatise nurses or patients who smoke’. It has drawn particular attention to the issue of long-stay patients and those with mental health problems. Marjorie Wallace, chief executive of SANE, said that while patients with mental illness ‘should have the choice of living in a smoke-free environment…those for whom being able to smoke is essentially calming should be allowed to do so in designated areas, as is currently the case’ (1).
What these health workers are arguing should be nothing more than common sense: that even though smoking is bad for an individual’s health, to outlaw smoking with a blanket ban is not necessarily good for the individual, particularly when that individual is in a vulnerable position, confined to hospital and unable to choose to leave that smoke-free environment. But the fact that the official guidance on smoke-free hospitals did not recognise this problem in the first place shows just how far common sense has moved away from the smoking debate in Britain.
What started with the widespread recognition that smoking is very bad for your health has become transformed into the first phase of the official attack on irresponsible lifestyles, and the government sees no barriers at all to driving home its message. Science is distorted, public opinion is manipulated, health professionals are turned into lifestyle policemen (if not jailers), and children are used to hammer home the unequivocal message that smoking not only shortens your life, it ruins the lives of everybody around you. And anybody who questions the illiberal, uptight climate this creates is dismissed with that bizarre label ‘pro-smoker’.
So in the interests of a more serious debate, let’s deal with the label first. Who, in all honesty, is a ‘pro-smoker’? Smoking is not a cause, but a habit. Nobody smokes because they want to change the world for the better or for the worse; and whilst the appearance of non-smoking signs in pubs might encourage the odd individual to light up to make a point, surely nobody really thinks that puffing on the cancer sticks is the way to make a political statement.
By the same token, spiked does not publish articles criticising smoking bans because it is a ‘pro-smoking’ website. The recent excellent article by the (non-smoking) New Yorker George Blecher on the Big Apple’s smoking ban received a flurry of responses, many wondering why spiked supports smoking (2). The answer is, we don’t. We work in a non-smoking office with a largely non-smoking staff, and we would rather that smoking was accepted as a filthy habit unworthy of note rather than treated as one of the key political issues of our age. But it has become a political issue, and one that is important to the questons of liberty and choice.
Because while smoking is not a cause, anti-smoking has become a crusade. Such is the official fervour for purging tobacco from our society that liberty and choice have been redefined out of existence. The once-cherished principle that an individual should have the liberty to live as he wishes, provided that he does not harm other people, has been transformed in anti-smoking parlance into the liberty of individuals not to be exposed to other people’s smoke. The idea that people should be able to make choices about their own lives, even if those choices are bad ones, has been transformed into the ability of people to choose a smoke-free environment to live and work in.
These are powerful arguments, and effective ones, pitting the cringeing figure of the guilty, unhealthy smoker against the health and happiness of the non-smoking majority. And if liberty and choice were principles that simply applied to smoking, there really would be little reason to oppose them. But the scientific and philosophical trickery involved in these arguments make them dangerous for broader reasons.
The power of the argument that smoking damages other people’s health rests on the widely accepted notion of the dangers of passive smoking. The idea that Environmental Tobacco Smoke (ETS) is harmful to non-smokers in the same way as tobacco smoke is harmful to smokers has been aggressively promoted, for obvious reasons. While a smoker knows that smoking is bad for him, ultimately it is his choice to smoke and suffer the consequences, and in a free society there are limits to what the authorities can do to stop individuals making such choices about their own lives. But if it can be said that smoking actively harms the health of others, this provides the justification for curbing individuals’ choices in the name of the common good.
However, as Dr Michael Fitzpatrick – a stalwart non-smoker, by the way, who for a long time has advised his friends and patients that smoking is very bad for you – argued on spiked in November, ‘despite the growing medical (and political) consensus about the dangers of passive smoking, the issue has remained controversial.’ (For a detailed account of why, see We have ways of making you stop smoking, by Dr Michael Fizpatrick.)
Critics are right to draw attention to the way that Big Tobacco in the past manipulated evidence about the dangers of smoking. But the promotion of the message that smoking is bad for other people’s health does a similar thing, politicising scientific evidence by using it for instrumental ends, and to justify restrictions on liberty and choice. This is a dangerous trend, and to accept that the abuse of scientific evidence is legitimate in the name of anti-smoking means accepting it in other areas of social life and policy too.
As well as pushing the alleged negative health effects of passive smoking, official anti-smoking campaigns have hit a new low in emotional manipulation, by emphasising the effects that an individual’s choice to smoke has upon other people. A £6million government advertising campaign launched over the Christmas period focuses on children: children laying flowers on a parent’s grave; a mother struggling to break the news that she has cancer to her children. The adverts carry the slogan: ‘Giving up smoking – the only way to protect your family.’ (3) The clear message is that if you don’t care about your own health, you surely care about your children; and if you won’t give up smoking for your own reasons, you must do it for the sake of your kids.
There is something thoroughly nasty about this shameless attempt to use children as a way to tap into parents’ deepest cares and fears – and it is disturbing that we live in a climate where this stuff is just accepted. It is assumed that the anti-smoking imperative is so strong that nothing is off-limits – the authorities have free rein to use any technique at their disposal to bully and frighten the public to make the right choices about their health and habits. Again, to accept that this is legitimate with regard to smoking means accepting that it is legitimate in other areas of life – the food we eat, what we drink, how much exercise we take. Anti-smoking is not the exception here, but the precursor to the rule.
We can already see, from the feverish debates about obesity and alcohol that have dominated the press over the past few months, how the acceptance of the tactics used by anti-smoking crusades has paved the way for more intrusive policy elsewhere. The calls to ban ‘junk-food’ advertising, proposals for greater regulation of the food on sale to children in schools, official attempts to guilt-trip parents into making sure that their children eat correctly…. Despite the fact that nobody, surely, really thinks that a burger is the same as a cigarette, the war on junk food is strikingly similar to the battle against smoking.
In a frightening parallel, at the same time as healthcare workers brought to light government plans to use hospitals as a site for enforced cold-turkey for long-term patients who smoked, a 33-stone man with an inherited condition that resulted in obesity was sectioned against his will, by health services purportedly acting for his own good (4). This kind of illiberal climate gives the authorities more power to intrude into our personal lives, even as the ‘public health’ justifications for doing so become more and more spurious.
And the opposition to such measures, unfortunately, becomes weaker and more apologetic. When the Royal College of Nurses opposed the proposals to outlaw smoking completely in the NHS, it justified its opposition by claims that long-term patients and nurses are victims of a powerful addiction, and that it cannot be assumed that they choose to smoke or that they can choose to give up. The RCN has announced plans to run ‘smoking cessation’ campaigns among its nurses, and is also backing a bill to ban smoking in all enclosed workplaces in Liverpool (5).
This is the kind of argument that our victim culture gives birth to, and obviously it meets with a more sympathetic reception than political points about liberty and choice. But it is an argument that invites more, not less, intrusion into our lives ‘for our own good’, and fuels the notion that people do not have the capacity to make choices and therefore should not be given free rein to make them. Whether the issue of the day is smoking, food or drinking, we should reject this pathetic caricature of humanity, and defend to the hilt the right to make the wrong choices.
Jennie Bristow is speaking at the spiked-conference Whose Choice is it Anyway? in London on 11 March 2005.
(1) Smoking ban ‘may harm patients’, Nick Triggle, BBC News, 22 February 2005
(2) Healthier in lungs, poorer in spirit, by George Blecher
(3) Anti-smoking ads feature children, Yahoo! news, 26 December 2004
(4) Thirty-three stone man sectioned, BBC News, 21 February 2005
(5) Royal College of Nursing response to the Guidance for Smokefree Hospitals, Royal College of Nursing, 26 Jan 2005; ‘British Medical Association backs Smokefree Liverpool’s private bill’, British Medical Association, 23 February 2005
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