Trading one problem for two: The case against tobacco bans.

Abstract

The past two decades have seen growing calls for the "tobacco endgame." Its advocates are united by their commitment to two ideas. First, tobacco-related harms represent a catastrophic health emergency, and second, current tobacco-control approaches are an inadequate response to the scale of that emergency. To endgame advocates, tobacco policy should have more ambitious goals than merely "controlling" tobacco. Instead, it should aim to bring about a smoke-free world. While a range of different policies are included under the umbrella of the "tobacco endgame," the most radical proposal is for a complete ban on tobacco. Its advocates argue that in addition to improving global public health, an effective ban on tobacco would also promote overall autonomy and would have important egalitarian benefits. This article critically examines these arguments for a tobacco ban. I argue that they rely on idealizing assumptions about the likely effects of a ban. Because an effective ban would require robust enforcement to control the illegal market in tobacco, it would be more likely to undermine autonomy and equality than it would be to promote them. By relying on idealizing assumptions and ignoring the likely consequences of a tobacco ban, advocates of a ban obscure, rather than clarify, both the policy debate and the ethical stakes. I conclude by considering the ways that idealizing assumptions should-and should not-play a role in debates about ethical issues in public policy.