The BMA: modern-day prohibitionists

The British Medical Association is dressing up moralistic attacks on smoking and drinking as health policy.

Max Klinger

Topics Politics

In the past, attempts by the state to prevent the consumption of alcohol were known as prohibition. Now they’re called ‘promoting public health’. The ultimate goal is the same though: the diminution of our rights in the name of ‘the public good’.

Fresh from browsing George Orwell’s Nineteen Eighty-Four for tips on good government, the British Medical Association (BMA) last week issued a series of demands following its annual conference. These included the introduction by the government of restricted licensing hours, a ban on alcohol advertisements, and a minimum price per unit of alcohol.

Dr Paul Darragh, chairman of the BMA’s council in Northern Ireland, claimed: ‘A range of substantive measures are needed to reduce alcohol misuse… Increasing the price of alcohol in particular will have a twofold effect. Not only is there likely to be an effect at a population level, but there is evidence that heavy drinkers and young drinkers are responsive to price.’

The BMA conference also decided to support the introduction of a smoking ban in cars while driving. ‘This motion further emphasises that smoking is unacceptable’, Darragh proclaimed.

Given that one of the BMA’s avowed aims is to make the UK ‘tobacco free by 2035’, its decisions are hardly surprising. They do, however, shed light on the illiberal nature of much of contemporary thinking regarding alcohol and smoking. Usually based on an appeal to protect others from the actions of an offending minority, there is a more authoritarian streak inherent in the current movement for prohibitive policy than such justifications suggest. The BMA has effectively declared its aim to be the denormalisation of certain activities and for others to be criminalised outright. Smoking is ‘unacceptable’ to the BMA not simply because of the effects of secondhand smoke on others, but because of the nature of the activity itself.

Let me illustrate what’s really going on with a hypothetical situation. Suppose you’re introduced to me at a pub. As we talk, I notice a man light a cigarette. Despite the protests of the publican, who is perfectly happy for the man to smoke, I inform him that it is bad for my health and that he must leave the pub to smoke. I then instruct the publican to ban smoking within the room. Frustrated, the man decides to buy a beer instead with his remaining £3.00. The barman informs him that a beer now costs £3.10, due to a new governmental tax. The man dejectedly exits the pub, and sits in his car alone to smoke. As he begins to drive off, I tap on the car window and inform him that he cannot smoke in his car, as children may be present (although they are not).

Despite earlier claims to the contrary, it appears that my real intention is to stop the man from smoking altogether. The prohibitive nature of the drinking tax is also apparent. In his famous essay On Liberty, John Stuart Mill wrote of such taxes: ‘Every increase of cost is a prohibition, to those whose means do not come up to the augmented price. To tax stimulants for the sole purpose of making them more difficult to be obtained is a measure differing only in degree from their entire prohibition, and would be justifiable only if that were justifiable.’

Mill’s criticisms are as true today as they were in the nineteenth century. Such policies are based upon a specific conception of the ‘right’ way to live, held by certain powerful groups.

The BMA’s thinking stands in stark contrast to the principle of enlightened reason, which sees man as an autonomous agent, capable of exercising rational judgement in order to determine his own life as he sees fit. Prohibitionists believe that, left to our own devices, we will make the ‘wrong’ decision and that the government must therefore impose the correct choices upon us. Like the preordained sovereigns of old, the BMA’s members believe they alone are privy to the unquestionable ‘truth’ according to which the rest of us must live our lives. The decision to smoke or drink more than the ‘recommended amount’ cannot be anything but the actions of a fool who has strayed from the correct path. To me, that sounds less like the ‘truth’ and more like the commands of a prudish grandmother.

The insidious growth of this puritanical moralism can be witnessed across much of the Western world. Alcohol taxes have been steadily increasing. New York recently banned smoking in parks and on beaches; a similar ban has been proposed for the less glamorous town of Stony Stratford, which would be the first such ban in England. In Iceland, parliament will soon vote on whether or nor to outlaw tobacco altogether, making it impossible to purchase without a doctor’s prescription.

Advocates of these bans disregard any notion of the right to free choice and personal autonomy. What the BMA is asking for is the imposition of greater restrictions on the ability of the individual to act how he or she chooses, based upon the opinion of medical professionals as to how people should behave. But is it the role of medicine, or the government more generally, to force a particular lifestyle upon us?

No, it isn’t. The role of the doctor is to provide the patient with all the available scientific knowledge, in order that he or she is best equipped to make a decision regarding his or her own body and life. It is not the prerogative of doctors or nurses to force the patient to behave as the doctor sees fit. If a doctor tells me that I am likely to injure my leg playing football, and I decide to play, she cannot stop me. Similarly, if I choose to drink and smoke, that should be my decision.

In the BMA’s proposals, we see the medicalisation of what is essentially a political issue. Whether I am allowed to drink or smoke is not a question that can be resolved on a purely scientific level. It brings into play more fundamental questions regarding our rights that should not be overridden simply by an appeal to medical science. The tendency for today’s prohibitionists – and promoters of many new policies more generally – is to couch their objectives in the language of science. A moral position is repackaged as a scientific truth that necessitates a particular course of action – the one that they are demanding.

The ideological and moral distinctions of old have been replaced by this scientifically justified politics of behaviour. This is not a progressive trend. We are a nation of rational adults, capable of determining our own affairs. I, for one, don’t want the government banning me from smoking or drinking, just as I don’t want it to ban flip flops in case I stub my toe. I might conclude that its arguments make sense – I might choose not to smoke or to cut down on drinking or avoid flimsy footwear – but the final say in these matters should be mine.

It was once said that ‘prohibition makes you want to cry into your beer, and denies you the beer to cry in to’. The BMA want to nick your cigarettes as well. As doctors and health campaigners push for greater state control over our personal lives, we need to send them packing. I’d drink to that.

Max Klinger is a student at Homerton College, Cambridge and a spiked intern.

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Topics Politics


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