In a letter sent to the editor of the New York Times and released on the Action on Smoking and Health (ASH) web site, ASH calls on physicians who suspect that parents of their pediatric patients are smoking in the presence of these children after being informed of the health risks be reported to authorities for investigation of child abuse.
The letter comes in response to a June 14 Wall Street Journal column by a pediatrician who argued that smoking around children is "a legal form of child abuse." The pediatrician writes: "I've had patients leave my practice because we've told them that they were harming their children's health and their own by smoking. ... I feel bad for the kids, but I don't miss dealing with their stubborn parents. I'd like to see what six months in a non-smoking foster home would do for the breathing of some of my pediatric asthma patients. Maybe that would be a wake-up call for their parents."
ASH writes: "Dr. Brewer writes very movingly about children brought to his office with serious breathing problems and other conditions caused by parents smoking around them, and says that talking -- even "a more assertive approach" -- often doesn't get them to change their behavior, which he characterizes as "a legal form of child abuse." It is!
We recommend that if talking doesn't work, physicians should file a formal complaint of suspected child abuse (or child neglect or reckless endangerment) the same as they would if a child were regularly being subjected to other toxic and carcinogenic substances like asbestos or benzene. Courts and social welfare agencies are beginning to react, and have issued thousands of orders prohibiting smoking in a car or home when a child is present.
The law not only requires physicians to report cases of suspected child abuse, but also shields them from legal liability for doing so."
The Rest of the Story
I have already discussed the numerous reasons why treating smoking around children as child abuse is a terrible idea and why it would cause irreparable harm to many kids, not the least of which is the fact that the ultimate remedy in child abuse proceedings - removal of children from their parents - would be a disastrous outcome for children exposed to secondhand smoke.
Here, I want to make several points. First, the argument that the pediatrician makes reveals exactly why ASH's recommendation, if heeded, is likely to harm childrens' health. He mentions that patients have left his practice because he has told them they were harming their children by smoking. Can you imagine what would happen if parents were to be reported to authorities for smoking around their children? They would be extremely reluctant to present to physicians for medical care for their kids. The action that ASH is recommending would essentially eliminate or severely limit access to needed health care for large numbers of the nation's children.
Second, it is quite scary to me that a physician is actually suggesting that kids should be removed from their parents as a health promotion intervention. There are lots of ways available to us in public health to motivate people to change health behaviors, but forcibly breaking up families and removing children from their parents is not one of them.
Third, you cannot have a "legal" form of child abuse. By definition, child abuse is illegal. So if you want to make smoking around children a form of child abuse, then by definition, smoking around children must be unlawful. If ASH is admitting that smoking around children is entirely lawful, then there is no argument that it should be reported to authorities as child abuse. It clearly is not. What ASH would have to argue is that smoking around children is actually not lawful under current child abuse law.
You can't have it both ways. You can't try to avoid being shunned by the public by arguing that you are not suggesting that smoking around children is unlawful, but then suggest to physicians that they should report parents who are complying with the dictates of law for child abuse.
The very fact that these groups acknowledge that smoking around children is lawful demonstrates the recognition by society that child abuse laws are not and were never intended to apply to widely recognized legal behaviors like smoking. We cannot and should not re-interpret laws in such a wild manner simply because some fanatical anti-smoking groups are unable to understand the attributes of child abuse.
Finally, it is important to note that ASH is actively pushing this aspect of the anti-smoking agenda. And that nobody in the anti-smoking movement is speaking out against them. This means that treating parents who smoke around their children as child abusers is now officially a part of the anti-smoking agenda. That's an agenda with which I don't want to be associated.