Thursday, August 16, 2007

New York City Council to Consider Bill to Ban Smoking in Cars Carrying Minors

The New York City Council is set to consider a bill that would ban smoking in all cars carrying passengers under the age of 18. The bill, which will be introduced by Councilmember James Gennaro – chair of the Council’s Environmental Protection Committee – establishes a fine of $200-$400 for a first offense, $500-$1000 for a second offense, and $1000-$2000 for third and subsequent offenses within a year. It would be enforced by the city’s police force.

According to a New York Sun article, Councilmember Gennaro explained the reasoning behind the bill as follows: I am just seeking every opportunity I can to denormalize smoking and to try to put it out of the reach of kids. I've lost family members to lung cancer and I've seen what happens.”

In response to opponents who expressed concern about the invasion of privacy and interference with personal liberties, Councilmember Gennaro was quoted as stating: “Boo-hoo. You can't subject kids to 43 carcinogens and 250 poisonous chemicals and claim privacy. Get over it. Their right to privacy doesn't extend so far as to poisoning kids.”

Also according to the article: “A child who spends one hour in a very smoky room is inhaling as many dangerous chemicals as if he or she smoked 10 or more cigarettes, according to the Mayo Clinic. A U.S. Surgeon General's report from 2006 found there is sufficient evidence to infer "a causal relationship" between secondhand smoke exposure from parental smoking and lower respiratory illnesses in infants and children.”

Audrey Silk, the founder of CLASH (Citizens Lobbying Against Smoker Harassment) is quoted in the article as warning: "If they can come into our car, then they can come into our home. And everybody should be afraid of this, not just because of smoking."

The Rest of the Story

Although I am an anti-smoking advocate and a supporter of workplace smoking bans, I do not support this particular proposal. While recognizing the potential dangers of childhood exposure to secondhand smoke, I simply do not believe that the government should be in the business of dictating parental choices about the health risks to which their children are exposed.

Here’s the best way to look at this: If the car smoking ban is justified, then it is also justified to ban smoking in homes in order to protect children from secondhand smoke exposure. In fact, it is even more important to prevent tobacco smoke exposure in the home, since that is where the overwhelming majority of such exposure takes place. However, most people recognize that intruding into the home to regulate health risks to which parents expose their children does represent an undue intrusion, a violation of privacy, and an unacceptable interference with parental autonomy to make decisions regarding the health risks to which their children are exposed.

There is no question that the government has an interest in protecting children from secondhand smoke exposure. There is also no question that the government is justified in taking action that interferes with parental autonomy when it comes to behaviors or exposures that directly harm children or put them at substantial risk of extremely severe, immediate, life-threatening consequences.

But in my view, for the government to be justified in intruding into parental autonomy, one of these two conditions must be met. Either the activity in question has to be one which causes direct harm, or it has to be one which puts a child at risk of severe, immediate, life-threatening consequences.

Thus, for example, I believe that laws which prohibit parents from beating their kids are justified. Physical abuse represents direct harm. Furthermore, laws which require that children be restrained in safety seats are also justified, because the failure to protect a child in this way could result in death or severe, immediate injury in the case of an automobile accident.

However, a law requiring that parents place infants on their backs in their cribs would not be justified. There is no question that placing infants on their front sides tremendously increases the risk of sudden infant death syndrome (SIDS). And there is no question that a law requiring parents to place infants on their backs would save many lives. However, such a law would be unjustified because it interferes with parental autonomy regarding a behavior that merely presents an increased risk of death. It does not necessarily involve any harm to a child. Clearly, in most cases, the child will not die of SIDS, even if sleeping on his or her front side.

Similarly, a law requiring that parents not feed their children fast food, fluff, high-fat food, or food with high levels of trans-fats would also not be justified, as it interferes with parental autonomy regarding decisions about health risks. There is no question that parents who feed their kids junk food day and night are putting those children at increased risk of a number of serious adverse health outcomes. But decisions regarding behaviors that place children at increased risk of disease should remain highly protected aspects of parental autonomy.

There is another serious problem with this proposed law. If the City Council is truly concerned about reducing tobacco smoke-related morbidity in children and is willing to ban smoking by parents in order to reduce tobacco smoke exposure, then it makes absolutely no sense to ban smoking only in cars. The overwhelming majority of children’s exposure to secondhand smoke occurs in the home.

While kids may be in a car with their parents for a half hour or so, they are in the home all the time. Many kids in the City do not even ride in cars often. But they are in the home all the time. There is no question that to put a substantial dent in tobacco smoke-related morbidity among New York City’s children, one would have to address smoking in the home.

In some ways, what this proposal does is to take the easy way out. It takes the less politically courageous step of only addressing smoking in cars, allowing policy makers to feel good that they have done something to protect kids, but with the truth being that they have failed to protect kids from the major source of the very problem that the policy makers claim they are interested in addressing.

You see – once the policy makers have declared that their intention is to protect kids from parental exposure to secondhand smoke and that they are willing to override parental autonomy in order to do so, then they are (in my view) ethically obligated to ban smoking in homes as well.

One must ask the question: why ban smoking in cars to protect kids from fleeting exposure, and allow parents to continue exposing their children to secondhand smoke for hour upon hour, day after day, in the home?

The only way out of this predicament would be to argue that you believe that interfering with parental autonomy in the home would be a violation of privacy. However, Councilmember Gennaro has already said: Boo-hoo. You can't subject kids to 43 carcinogens and 250 poisonous chemicals and claim privacy. Get over it. Their right to privacy doesn't extend so far as to poisoning kids.”

Fine – but if parents’ right to privacy doesn’t extend so far as to poisoning kids with secondhand smoke with its 43 carcinogens and 250 poisonous chemicals, then that right to privacy doesn’t extend to smoking in the home either.

So then why isn’t the Councilmember proposing to prevent parents from poisoning kids in their very own homes?

The answer, I believe, is that a home smoking ban would not be politically popular. Far easier it is to take the politically expedient route and ban smoking in cars so that you can claim you are doing something when in fact, you are neglecting the bulk of the very problem you claim to be addressing.

The rest of the story is that by focusing on such a small aspect of childhood exposure to secondhand smoke, these car smoking bans are actually distracting attention from where it needs to be: developing and funding programs to educate parents about the effects of secondhand smoke and to encourage them (not force them) to avoid smoking around their children – no matter where they are.

What good does it do for a parent to avoid smoking around their children in the car, but to smoke around them all day long in the home? And I can assure you, if a parent is smoking with their kids in the car, they sure as heck are going to be smoking in their own home.

I know that I am going to be attacked by my colleagues for taking this position in opposition to a smoking ban. But the reality is: I feel my position is a much more productive one that seeks to actually address the most significant problem. Car smoking bans are largely window dressing that allow us to feel good about ourselves, but which do very little to actually prevent childhood morbidity due to tobacco smoke exposure.

Ultimately, I agree with Audrey Silk: “If they can come into our car, then they can come into our home. And everybody should be afraid of this, not just because of smoking.”

At issue here really is the sanctity of parental autonomy over decisions regarding the welfare of their children. If we are willing to supersede parental autonomy when it comes to one health behavior that increases children’s risk of adverse health consequences, then we are going to be willing to do so for other health behaviors. And that would take us to a place that I assure you we do not want to go.

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