{"id":1379,"date":"2011-11-18T13:15:14","date_gmt":"2011-11-18T12:15:14","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=1379"},"modified":"2011-11-18T19:15:55","modified_gmt":"2011-11-18T18:15:55","slug":"smoking-in-cars-and-the-bma-the-counterwheeze","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2011\/11\/18\/smoking-in-cars-and-the-bma-the-counterwheeze\/","title":{"rendered":"Smoking in Cars and the BMA: The Counterwheeze"},"content":{"rendered":"

You can tell libertarians from the sound they make: it’s the faint rattle of a tiny intellect untethered in an otherwise empty mind.\u00a0 Cheap and all-too-easy insults aside, though, I’d been wondering how long it’d be, in the wake of the BMA’s recommendation that smoking be banned from cars<\/a>, before we got a response from the libertarians.\u00a0 The answer, it seems, is a couple of days.\u00a0 The Libertarian Alliance, for example, has had a go<\/a> (it’s a totalitarian tax ruse, I tells ya!\u00a0 Thank goodness tax is low on tinfoil hats…); but the example that really caught my attention – by which I mean rendered me slack-jawed in amazement – was this piece<\/a> by\u00a0Rob Lyons\u00a0in Spiked<\/em>, the online journal of choice of the bewildered.<\/p>\n

There’re two aspects to questions about smoking in cars: the scientific and the moral. \u00a0They’re related – the science provides the context for the moral debate – but oughtn’t to be confused, and neither is reducible to the other. \u00a0And I won’t say a great deal about the scientific aspect, for a couple of reasons: first, not being a scientist, I’m probably not qualified to say much; second, the BMA has already had to backtrack a little over one of its claims, and I suppose that there’s room to dispute about the precise figures of some of the others.<\/p>\n

Nevertheless, there’s a small handful of scientific points about which you don’t have to be a Nobel laureate to talk. \u00a0The first is that, though there might be reasonable dispute about just how dangerous second-hand smoke is, I think that it’s fair to say that the evidence is overwhelming that it is to some degree dangerous. \u00a0The second is that the chemicals from cigarettes do accumulate in confined spaces (such as cars): if I get into your car and it smells of fag-ash, that’s because there’re at least some cigarette-related chemicals floating around there. \u00a0On the assumption that some cigarette-associated chemicals are dangerous, and all else being equal, it’s reasonable to assume that I’m at a greater risk by getting in to your car than I would have been by not doing so. \u00a0(Incidentally, there’s quite a nice little demo of the difference that a cigarette makes on the atmosphere in a car on the Sky news site<\/a>.)<\/p>\n

The trouble in which the BMA found itself had to do with its claim that the concentration of toxins in a smoke-filled vehicle could be up to (and there’s a weasel phrase: “up to” means “less than”) 23 times greater than in a smoky bar; it’s now revised this down to 11 times. \u00a0(H\/t to VGIF<\/a> for picking that up.) \u00a0On the other hand, I’m not sure what that statistic is supposed to show anyway; invoking it was probably a tactical blunder by the BMA, because it was a gift to the pro-smoking lobby. \u00a0It doesn’t matter whether smoky bars are more or less dangerous than smoky cars, or by how much. \u00a0The comparison ought to be between smoky and non-smoky cars. \u00a0Quite why bars are cited is a bit of a mystery to me, unless you’re driving home from the pub – in which case, other worries are more pertinent.<\/p>\n

But enough about the science: on to the ethics, and, in particular, the Spiked<\/em> article. \u00a0It’s a long piece, so I’m going to home in on a few aspects.<\/p>\n

The first is Lyons’ assertion that passive smoking causes very low levels of morbidity and mortality; it’s a claim he’s made before<\/a>:<\/p>\n

A thousand deaths seems like a terrible death toll until set against the 600,000-plus deaths that occur in the UK each year, in a population of 60 million. Even if we were to take these figures at face value, a quick back-of-a-fag-packet calculation suggests that one in 60,000 people die each year because of passive smoking.<\/p><\/blockquote>\n

One in sixty thousand doesn’t sound like a lot; but that is, as Lyons admits, still a thousand people over all. \u00a0That’s a\u00a0thousand people killed prematurely by the effects of someone else’s addiction – and whose deaths Lyons appears to think not worth preventing. \u00a0If I dumped a toxic chemical and caused the deaths of a thousand people a year, I think I’d be strung up; and I think that being strung up might well be warranted. \u00a0Pleading that there’s still well over 59 million people I’d not<\/em> killed would be somewhat pathetic. \u00a0And that’s before we begin to count the economic cost of lost work days, and the drain on the NHS.\u00a0 (UPDATE: Of course, no single smoker causes a thousand deaths; but the point stands that, if there were any other practice that predictably caused that much mortality, it’d be a cause for concern.)<\/p>\n

Lyons then moves on to a claim that “a sizeable proportion of parents won\u2019t smoke in front of their kids already”. \u00a0This claim is based on a finding that many parents go outside to smoke when at home. \u00a0Very well: but that tells us nothing about cars. \u00a0As with the smelly car point above, not actually smoking in front of the kids while driving is irrelevant if the chemicals from the smoke are still circulating. \u00a0Next up is the claim that, if smokers drive with the windows open, there’s a great deal less smoke in the atmosphere than there would be in a bar. \u00a0I’ve already explained why this is a red herring; but I’m also wondering whether smokers will reliably have the window open anyway. \u00a0What if it’s pissing down, or freezing cold? \u00a0Are passengers simply expected to choose between exposure to the elements and exposure to carcinogens? \u00a0What about exposure to neither? \u00a0(Note, too, that the tests refer to open windows<\/em> – plural. \u00a0All of them? \u00a0Fully open?\u00a0\u00a0Frankly, I’d rather get the bus.)<\/p>\n

Now come the really big claims – and the big blunders.<\/p>\n

The reality is that the demand for prohibition has got nothing to do with scientific evidence and everything to do with moralising. The briefing reminds us of the \u2018BMA\u2019s desire for UK governments to achieve a tobacco-free society by 2035\u2019. Essentially, the BMA\u2019s hierarchy detests the idea that you or I might choose to engage in a pleasurable activity that could possibly shorten our lives. These petty puritans believe it is their God-given right to tell us how to live – and the corridors of power are increasingly stacked with politicians and bureaucrats that share this sentiment.<\/p><\/blockquote>\n

Gee whizz! \u00a0An organisation of health professionals speaks publicly about health-related matters! \u00a0Still, I’m slightly puzzled about whether smoking really is a pleasure. \u00a0Most people don’t enjoy their first cigarette: it’s a habit they have to acquire. \u00a0But, not being a smoker, I’m also led to wonder whether there’s really much enjoyment to be had from subsequent ones. \u00a0(Maybe there is. \u00a0I’m sure someone’ll tell me.) \u00a0For sure, there’s the fact that craving nicotine might well be unpleasant, and relief of something unpleasant is desirable; but it’s a stretch to ascribe pleasure to smoking as a result. \u00a0Taking off ill-fitting shoes gets rid of an unpleasant feeling; but it’s hardly a pleasure in any serious sense: you don’t put on ill-fitting shoes so that you can enjoy taking them off. \u00a0And, of course, there’s the sleight of hand as Lyons shifts the attention from what people do to others to what they do to themselves.<\/p>\n

He continues by admitting that<\/p>\n

there is a\u00a0moral<\/em> argument to be had about smoking in cars. You might very reasonably argue that in such a confined space, it is a bit anti-social to smoke in front of others, at least in a manner that would cause them irritation. Most people resolve this through compromise between one person\u2019s desire to smoke and another person\u2019s desire for fresh air.<\/p><\/blockquote>\n

Sorry to interrupt, but: no, not really. \u00a0It’s not a matter of compromise. \u00a0We aren’t comparing two equivalent but incompatible goods. \u00a0The situation is one in which Smith knowingly exposes Jones to a dangerous chemical (and so we aren’t talking about being a bit antisocial either). \u00a0If Jones objects, or the State acts on Jones’ behalf, Smith doesn’t have the option of coming back and offering just to expose Jones a little bit. \u00a0The right not to be exposed to a toxin simply isn’t comparable to any putative right (ha!) to expose others to that toxin. \u00a0The latter right ain’t no such thing<\/em>. \u00a0What Lyons ought to be comparing is the right not to be exposed to toxins with the smoker’s desire to do something (allegedly) pleasurable. \u00a0And in that sort of case: well, pleasure – allowing, for the nonce, that smoking is pleasurable – can wait. \u00a0Part of being an adult is the ability to defer pleasure if it’ll inconvenience or harm others. \u00a0Pleasure is not a right.\u00a0 Perhaps it would be too much to legislate about inconveniencing others; but being exposed to dangerous chemicals is more than inconvenience. \u00a0Trying not to expose others to unnecessary harm is a duty.<\/p>\n

And then things get really<\/em> strange.<\/p>\n

But the moral argument about our habits just doesn\u2019t work today. We\u2019ve been told for years that we\u2019ve all got to make our own choices about the world and that there\u2019s no such thing as hard-and-fast morality anymore. That might seem like a good thing. After all, who wants some higher authority determining how they should live their lives? But unfortunately, the old moral campaigns to shift our behaviour have been replaced by new pseudoscientific campaigns to re-engineer us, as typified by the BMA\u2019s war on smoking. how I live my life.[sic<\/em>]<\/p><\/blockquote>\n

Try as I might, I can’t read this as anything other than the claim that there might have been a moral argument about banning smoking in cars, but that morality is obsolete nowardays. \u00a0This seems to amount to “God is dead, and so libertarianism is the only game in town”.\u00a0\u00a0If that’s what Lyons really does mean, it’s embarrassingly wrong. \u00a0You don’t need a “higher power” to talk meaningfully about moral rules, or even rules of social propriety, by which people ought to live. \u00a0You don’t need a higher power to think that they might be enforceable. \u00a0(Besides: if there really is no hard-and-fast morality any more, by what standard is that a good thing? \u00a0Lyons seems not to have noticed that he’s making an essentially moral claim. \u00a0Oh, well.) \u00a0And who is it that’s told us that there’s no hard-and-fast morality any more? \u00a0There’s certainly been a collapse in some of the old certainties, and there’s certainly been a certain kind of pluralism over the past couple of generations; but the fact of pluralism doesn’t warrant a metaethical claim that there is no hard-and-fast morality, and it doesn’t mean that there’s no such thing as a poor moral argument. \u00a0Plurality is not relativism, and there’re very few actual thoroughgoing relativists (notwithstanding my post from a couple of days ago).<\/p>\n

Neither is it clear that it’s correct<\/em> to say that there’s no hard-and-fast morality to be had, nor that there’s nothing at all that can be said about issues of moral import, be they famine or smoking.\u00a0 For example, I disagree with a lot of my colleagues about how\u00a0to do moral philosophy; but we all agree that certain things are wrong and others obligatory.\u00a0\u00a0Lyons’ claim is pretty much senseless.<\/p>\n

I spent a great deal of time after reading Lyons’ piece wondering whether it was incompetent or mendacious; but I’m not sure that I have to choose. \u00a0It could plausibly be both.<\/p>\n

UPDATE: Brendan O’Neill,\u00a0Spiked<\/em>‘s editor, compounds the silliness<\/a> in today’s Telegraph<\/em>…<\/p>\n","protected":false},"excerpt":{"rendered":"

You can tell libertarians from the sound they make: it’s the faint rattle of a tiny intellect untethered in an otherwise empty mind.\u00a0 Cheap and all-too-easy insults aside, though, I’d been wondering how long it’d be, in the wake of the BMA’s recommendation that smoking be banned from cars, before we got a response from […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1240,511,475,403,1241],"tags":[304],"class_list":["post-1379","post","type-post","status-publish","format-standard","hentry","category-blogosphere","category-in-the-news","category-politics","category-rant","category-tinfoil-hat","tag-public-health"],"yoast_head":"\nSmoking in Cars and the BMA: The Counterwheeze - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2011\/11\/18\/smoking-in-cars-and-the-bma-the-counterwheeze\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Smoking in Cars and the BMA: The Counterwheeze - 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