The truncation of moral reasoning on harm reduction by individuals and organizations.

Abstract

Hall, Gartner & Forlini 1 apply ethical philosophy to tobacco harm reduction. There are parallels between the ethical analysis of product bans and of misinformation (or disinformation) about the risks of products that are available in legal market-places 2-4. I agree that vaping products can be marketed in ways that will reduce the harms of smoking, minimize causal gateway effects and promote smoking cessation. Marketing's 4Ps (Product, Place, Promotion and Price) can alter product preferences 4, 5. Tobacco harm reduction principles should be included in public health approaches 5, 6 as one ‘pillar’ of public health 7, but objections to harm reduction remain widespread [8]. Challenges to progress arise in part because thorough moral assessments are uncommon by individuals or organizations. Research on moral psychology argues that rapidly processed ‘moral intuitions’ which are influenced by emotions are critical to moral judgments, and ‘moral reasoning’ is less often the creator of moral judgments than the defender of moral intuitions 9. The classic moral principles of autonomy, beneficence/non-maleficence and justice are involved in moral psychological issues of harm/care and fairness/reciprocity, but moral psychology identifies additional important moral principles such as loyalty to group/community, respect for authority and appreciation for sanctity/purity 10. On the continuum from ‘conservative’ to ‘liberal’ positions, none of the moral values disappear, but the relative importance of these values change 10. When community standards (loyalty and authority) are violated (by disagreeing with the opinions of a distinguished medical society), contempt can be felt. When there is a ‘contamination of the pure’ (by recommending e-cigarettes which are not perfectly safe), disgust can be felt. When individual rights are violated (harm, unfairness), anger arises. The interplay of the moral emotions of disgust, contempt and anger contribute to individual positions on harm reduction issues 11, 12. An example of the emotions arising in harm reduction disputes are depicted in this dramatic dialogue, which provides links to an audio performance on the journal website 13. Individuals working in institutions or organizations are also constrained by the biases and role responsibilities of their employers or organizations. Public and professional roles can affect the moral principles that are stressed and the positions that need to be defended, especially in adversarial contexts 14. Those who work for certain ‘Disease Control and Prevention’ organizations (public or private) would probably be most vigilant for any indications of negative consequences of e-cigarettes. They would be primed (and most rewarded) to find (a) any indication that e-cigarettes might act as a causal gateway to cigarettes and (b) any evidence that e-cigarettes are ‘not safe’. It would not be surprising if their workers would be reluctant to emphasize evidence that e-cigarettes could be preventing smoking or that they are much safer than cigarettes. In contrast, those aligned with advocating e-cigarettes for harm reduction would be similarly disinclined to promote any findings consistent with the possibility of a causal gateway to cigarettes or nicotine addiction. Organizations have, in effect, party-lines and preferred positions, and these influences act to truncate the extent to which complete, ethical analyses are conducted or published on any issue. Organizations in keeping with role responsibilities are likely to have their preferred principles and their own moral intuitions that limit what they think, do and are prepared to recommend. Although thorough assessments of philosophical ethics and policy implications may change some opinions, abiding biases in individuals and organizations promote truncation of evaluations, reduce objectivity and impair progress. Players (individuals and organizations) should (a) try to consider an application of moral reasoning that is as complete as possible and (b) try not to jump to conclusions when they have encountered their ‘hot-button’ preferred issues. In conflicts where participants believe they are ‘doing good’ that urgently needs to be done, one can also expect instances of ‘white hat bias’ 15. White hat bias refers to the ‘distortion of information in the service of what may be perceived to be righteous ends’ 15. Righteous zeal may be another kind of moral psychological influence (charged with anger, contempt or disgust) that further clouds the turbulent waters of applied science on controversial issues. None.