Thursday, November 16, 2006

Health Advocates in Bangor Pushing Legislation to Ban Smoking in Cars with Children

A group of local public health advocates in Bangor are pushing for legislation that would make it illegal to smoke in a car when a child is present. The ordinance, which would be enforced by the police as a secondary motor vehicle infraction, would impose a $50 fine for smoking in a car when any child under age 18 is present.

According to an article in the Bangor Daily News: "Bangor pediatric dentist and child health advocate Jonathan Shenkin is the primary mover behind the proposal. Shenkin said Friday that he was dismayed by a recent report from the Office of the U.S. Surgeon General. The report shows that despite a drop in smoking rates nationally, exposure to 'secondhand smoke' --— smoke in the air from a nearby cigarette or other smoking material --— remains high. 'The most shocking thing is that the population at highest risk -- is young children age 4 to 11,' he said."

"Physician Geoff Gratwick, who serves on the Bangor City Council, said Friday that he will sponsor the proposal enthusiastically. ... Gratwick said the ordinance should not be perceived as an intrusive or heavy-handed measure, but rather as an opportunity to raise awareness among parents and other adults about the serious health consequences their smoking can cause in the children they care for. 'If you love your children, this is something you should learn not to do,' he said."

The Rest of the Story

While I appreciate the desire to protect children from secondhand smoke exposure in cars, I'’m afraid that the proposal to ban smoking in cars occupied by children represents an unwarranted intrusion into the privacy and autonomy of parenthood. The autonomy to make one'’s own decisions about what risks to subject a child to is not to be interfered with lightly. It should only be done in cases where there is a substantial threat of severe harm to the child. Interfering with parental autonomy in a case where there is only minor risk involved is unwarranted.

Let me explain what I mean by substantial threat of severe harm and minor risk.

If an infant is riding in a car without a car seat, there is a substantial threat of severe harm should the car be involved in an accident. In fact, if the car is in any major accident, severe harm to the child is almost certain. Death is likely if the accident is severe. The connection between not being in the child restraint and suffering severe injury or death in an accident is direct, immediate, and definitive.

On the other hand, exposure to secondhand smoke in a car in most cases merely poses an increased risk of upper respiratory or middle ear infection. The likelihood, more often than not, is that the child will not suffer any harm. What is involved is only an elevation of risk for an ailment. There is no certainty of harm, nor is there any substantial threat of severe harm. The harm, if any occurs, is removed in time from the exposure and in most cases it is impossible to directly connect the exposure with the ailment. Thus, the connection is neither direct, immediate, nor definitive.

This difference is not subtle. In fact, it is so stark that it serves as the basis for deciding when society should interfere with parental autonomy regarding exposure of their own children to health risks. Generally, causing harm to children or putting them at substantial risk of severe, direct, immediate, and definitive harm is viewed as something for which there is a legitimate government interest in interfering with parental autonomy. Simply placing children at an increased risk of more minor health effects is not something for which there is a legitimate government interest in interfering with parental autonomy.

If we extended the argument of the supporters of this proposed legislation, then we would also have to support laws that regulate a wide range of parental activity that takes place in the private home which places children at increased risk of adverse health effects.

We would have to ban parents from smoking in the home. We would have to ban parents from drinking more than a drink or two at a time in the home. We would have to ban parents from using insecticides and pesticides. We would have to ban parents from allowing their children out in the sun without sunscreen. We would have to ban parents from allowing their children to ride giant roller coasters. We would have to ban parents from serving their children foods that contain trans-fats. We would have to ban parents from serving their children peanuts before age 3. We would have to ban parents from allowing their children to drink soda that contains sodium benzoate and citric acid.

And more:
  • Allowing their infants to play with walkers;
  • Allowing their children to watch more than four hours of television every day;
  • Failing to ensure that their children get adequate physical activity;
  • Owning a wood-burning stove;
  • Failing to filter water that contains trihalomethanes;
  • Not boiling their babies'’ bottles before serving them milk;
  • Not breastfeeding their infants;
  • Allowing their children to watch violent television programs;
  • Allowing their children to watch R-rated movies;
  • Serving alcohol at a party;
  • Allowing their children to drink alcohol; and
  • Failing to keep vitamins out of the reach of children.
One could easily argue that 'If you love your children, [these are all things] you should learn not to do.' That may or may not be true, but what is clear is that we should not interfere with parental autonomy by banning all of these things.

The question I find interesting is why a child advocate would single out smoking around one's children as the sole example of a situation in which the government interferes with the autonomy of a parent to make decisions regarding the exposure of her children to a health risk. What is it about smoking that, among all of the myriad above health risks to which parents often expose their children, it is the one and only one that is chosen to be regulated?

I fear that the answer is that there is a moral stigma attached to smoking as opposed to these other risky parenting behaviors. And I also fear that it is the anti-smoking movement that has contributed to this moral stigma. What it ultimately comes down to, I'm afraid, is that the anti-smoking movement is starting to moralize. We are starting to try to dictate societal morals, rather than to stick to legitimate public health protection.

It's a dangerous line that we're crossing. Because once that line is crossed, there's little assurance that the autonomy of parents to make decisions regarding raising their children can or will be adequately protected.

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