The ethics of policies for the prevention of tobacco disease

Public Health policy is widely assumed to be ethical. However, the field of tobacco control is extremely complex and opportunities to reduce the disastrous amount of harm caused by tobacco smoking involve taking calculated risks. These risks are avoided by doing nothing. However, doing nothing means accepting the status quo. More effective application of policies aimed at attaining abstinence from tobacco via prevention of initiation and promotion of cessation is needed. The development of other opportunities for harm reduction pose ethical challenges because they involve taking risks and thus may breach the basic ethics principle of doing no harm. These opportunities include consideration of regulating the smoke of tobacco products, of accepting more widespread use of Snus, the use of nicotine replacement therapy (NRT) in continual smokers, the acceptance of the concept of recreational addictive 'clean' nicotine, the regulation and acceptance of potential reduced exposure products (PREPs) and more widespread use of existing NRT. The experience with low tar cigarettes is presented as a cautionary tale.