Wednesday, August 11, 2010

Leading Physician in UK Calls Smoking in Cars with Children a Form of Child Abuse

Dr. Steve Field, a UK physician who is the chairman of the Royal College of General Physicians, has stated that smoking in a car with a child is a form of child abuse. He has also claimed that parental smoking kills more young children than all other forms of unintentional injuries.

According to an article at BBC News: "Parents who smoke in cars in front of small children are "committing a form of child abuse", a leading GP has said. Professor Steve Field, chairman of the Royal College of General Practitioners, has condemned society's attitudes to food, alcohol and cigarettes. In a letter to the Observer newspaper, he said parents had to take more responsibility for their children's health - and set a good example. He said irresponsible behaviour led to high levels of disease and early death. ... Professor Field, who represents 42,000 GPs across the UK, added: "I suppose the same people also smoke at home in front of their children. Evidence from the US indicates that more young children are killed by parental smoking than by all other unintentional injuries combined."

The Rest of the Story

I'm not aware that any significant number of young children are killed by parental smoking, much less more children than are killed by all other unintentional injuries combined. While secondhand smoke has been linked with deaths from sudden infant death syndrome, this affects infants - not young children. So the first problem is that Dr. Field is disseminating false, or at least very misleading information.

The second problem is that there are a number of severe problems with his argument that smoking in a car with a child is a form of child abuse.

First, this argument confuses the concepts of harm and risk. There is little doubt that secondhand smoke exposure during young childhood increases the risk of a number of adverse health conditions. But it doesn't necessarily cause harm. In contrast, child abuse is an act that results in inflicted injury - there is direct, immediate, and definite harm. Since smoking around a child does not usually inflict injury, it is not child abuse.

It is important to recognize that by Dr. Field's definition of child abuse, any woman who takes a drink of alcohol during pregnancy is a child abuser. There is strong evidence that alcohol use during pregnancy increases the risk of adverse health outcomes. Any woman who drives in a car with a child is also a child abuser. Riding in a car increases the risk of injury and death. So does changing cat litter while pregnant, another form of child abuse according to Dr. Field's logic. And I don't even want to talk about parents who serve their children raw fish. That increases the risk of intestinal infection, which could cause adverse consequences, and represents child abuse, according to Dr. Field's definition.

You can see how dangerous this type of argument is. If we adopted such a definition here, as suggested by Dr. Field, then any parent who allows their child to ride on a roller coaster is a child abuser. Letting your child play hockey is a serious form of child abuse. Parents of children who are allowed to play football are also child abusers, according to this argument.

A second problem with the argument is that it would treat people who smoke around children in the same way as people who beat their children. If we are unable to see a world of difference between these, then we have some serious problems that could truly put our children at risk. Ultimately, society addresses child abuse by removing children from the custody of their parents. Resorting to such an approach to deal with smoking would be a tragedy and would cause much more harm to children than is being caused by tobacco smoke in the first place.

A third flaw in Dr. Field's argument is that child abuse and physical abuse are terms that generally imply an intent to cause harm. The action that causes the harm is the primary intention of the perpetrator.

For example, when someone beats a child, the primary intent of the action was to beat the child. It is not the case that hitting the child was a secondary, unfortunate side effect of some other primary action.

But in the case of smoking around a child, it is not the primary intent of the alleged perpetrator of the "child abuse" to injure the child. The injury, if it does occur, happens as an unfortunate, unintended secondary consequence of the primary action, which was simply to smoke.

This is also why driving with kids in a car at 60 miles an hour on a crowded Los Angeles freeway is not child abuse, nor is changing a cat litter and getting toxoplasmosis, which can result in severe neonatal injury or death. The primary intention of the act of driving was not to injure a child, it was to get somewhere. Similarly, the primary intention of changing the cat litter was not to harm the neonate; it was to change the cat litter.

Hopefully, other physicians and anti-smoking groups worldwide will condemn these comments made by Dr. Field. Because if we are unable to differentiate between child abuse and exposure of children to secondhand smoke, we are going to end up causing far more harm to children's welfare than would be caused by secondhand smoke.

To be clear, I am not minimizing the hazardous effects of secondhand smoke exposure on children. However, equating this with child abuse minimizes the tragic effects of actual child abuse on its victims. It is an inappropriate, incorrect, insensitive, and irresponsible comparison.

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