Monday, March 12, 2007

Trading Small Risk for Severe Harm: Why Criminalizing Parental Smoking in Cars is a Terrible Idea

The Illinois legislature is currently considering a bill that would make smoking in a car with a child a criminal offense, punishable by a fine of up to $1,500 and up to one month in jail. A number of anti-smoking groups and advocates are supporting this and similar proposals which would ban smoking in cars with children present. Many of these bills do not make smoking in cars a criminal offense; however, bills being considered in Illinois, New Jersey, and New York do: repeat violations of the law could result in a jail sentence.

I have already expressed my opposition to these measures based on my belief that they represent an unwarranted intrusion into individual privacy and parental autonomy. I would oppose these measures whether they make smoking in cars a civil or a criminal offense. In this post, however, I specifically address those bills which would make smoking in cars with children a criminal offense and explain why I think these measures in particular are misguided and dangerous.

The Rest of the Story

Essentially, these laws would trade off small health risks (a small probability of relatively minor harm) for definite and substantial harm to children (a 100% probability of severe harm).

A child exposed to secondhand smoke for a short period of time in a car is at a somewhat increased risk of ear infections and upper respiratory infections. But that's it. We're not talking about the risk of death or severe injury or illness. And we're not talking about an extremely high probability of illness. Most children who ride in a car in which a parent is smoking for a short period of time will not develop an ear infection or an upper respiratory tract infection. What these laws are doing, then, is protecting children from a relative small risk of relatively minor harm.

In contrast, putting a child's parent behind bars for a month causes severe and definite harm to a child. There is nothing more harmful to a child than forced separation from a parent. We're not talking about an increased risk of an adverse consequence. We're talking about definite harm. And we're not talking about minor harm. We're talking about one of the most severe forms of harm imaginable.

How can we possibly trade a small risk of relatively minor health consequences for definite, severe harm to a child?

The answer is that we can't, or at least we shouldn't. That's why I view the proposals (such as those in Illinois and New York) which criminalize smoking in cars with a child present in order to protect those children as misguided and dangerous.

The rest of the story is that in their zeal to protect children from secondhand smoke exposure (which is admirable), a number of anti-smoking groups are going to cause definite and substantial harm to children (which is not admirable). In what possible way does forcibly removing a parent from a child protect that child? How can it possibly be in a child's best interest to remove a parent from them and lock him or her up in jail merely to prevent the slight possibility that the child might develop an ear or upper respiratory infection?

In cases of child abuse, I think that criminalization of the parent and removal of the child from the parent is a reasonable potential option because it is possible that the harm from the child abuse outweighs the harm from the removal of the child from the parent. If a child is being repeatedly beaten or sexually abused, that degree of harm unfortunately is so severe that removing the child from the parent may actually be in the best overall interest of the child.

But how is removing a parent from a child, even for a few weeks or a month, in order to reduce the risk of an ear or bronchial infection, in the best interests of the child?

I'm afraid that in our desire to reduce children's exposure to secondhand smoke, which is a laudable goal, we have lost sight of the broader and more fundamental goal: protecting children from harm. And in our desire to reduce health risks, we are now supporting proposals that are destined to cause harm for many children.

I think that we in tobacco control have become very narrow-minded in our view of the world. And that narrow perspective we now bring to public health is unfortunately going to start causing harm. Someone needs to speak out to try to open up our thinking and our perspective, and to remind us why we are doing this in the first place. I'm glad that's a role that The Rest of the Story can play.

While it is my hope that as many of the car smoking ban proposals fail as possible, I think it is particularly critical that the measures which making smoking in cars a criminal offense go down to defeat. Enacting such measures is not in the best interests of our children.

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