匹兹堡大学:电子烟危害远小于卷烟

公共卫生伦理强调实现公共卫生目标应“尽量减少侵犯个人权利和自由”。无论烟民决定接戒烟还是改用电子烟,我们都应表示尊重。
 
近日,美国匹兹堡大学的3名研究学者在其发表的研究论文中指出,电子烟危害远小于卷烟,应将“电子烟可用性”(E-Cigarette Availability,简称ECA)作为一项烟草减害战略。
 
电子烟危害远小于卷烟
 
《烟草减害伦理:从功利主义、生物伦理学和公共卫生伦理学角度分析电子烟可用性》
 
“电子烟可用性”,是一项鼓励烟民改用电子烟的群体性干预措施。它包含两层含义:让烟民清楚知晓电子烟比卷烟减害,并确保他们能方便地获得电子烟。
 
论文作者指出,“电子烟可用性”得到了公共卫生伦理和生物医学伦理两大伦理框架的支持。“电子烟可用性”能帮助烟民减少健康风险和危害,并让烟民自己做出健康决定,符合尊重个人权利和自主权原则,促进了社会公平和正义。同时,用“电子烟可用性”实现公共卫生目标,比传统的控烟做法,遇到的限制最少。
 
“公共卫生实践的核心是最大程度减少不良行为对公众健康的影响,而非完全消除不良行为。”
 
作者在论文中强调:“关注群体与尊重个人权利并不冲突,(公共卫生)官员和医生应鼓励烟民改用电子烟,减少侵犯烟民的个人权利和自由。”
 
“无论烟民决定戒烟还是改用电子烟,我们都应表示尊重。”
 
生物医学伦理框架曾提出四项原则,即尊重自主权、仁慈(增加患者福利)、非恶意(避免伤害患者)和正义。电子烟危害远小于卷烟,让烟民改用电子烟,可以使烟民避免传统烟草带来的危害,因此符合仁慈和非恶意的原则。
 
更重要的是,这一方案还完全满足了尊重自主权原则的伦理需求。尊重自主权,指尊重个体根据自身意愿做出知情决策的权利。
 
为烟民提供电子烟产品及电子烟减害信息,可保证烟民在不受任何强迫和欺骗的前提下,根据自身价值观和偏好自愿做出选择,是尊重烟民权利的体现。
 
公共卫生伦理框架始终强调,实现公共卫生目标应尽量减少侵犯个人权利和自由。
 
即便是晚年才开始戒烟的烟民,也拥有追求减害的权利和自由。他们的权益一样需要保障。“每个人都有权利追求自己定义的幸福,无论烟民决定戒烟还是改用电子烟,我们都应表示尊重。”美国匹兹堡大学的Rebecca Thomas说,她也是本篇论文的作者之一。
 
“隐瞒、歪曲电子烟信息会让公共卫生机构丧失公信力”
 
既然烟民的个人权利应该得到尊重,为保证烟民做出明智决策,提供准确的电子烟信息就显得尤为重要。“他们(电子烟反对者)或许会说,‘让公众高估电子烟的风险’才更安全,但隐瞒、歪曲电子烟信息会让公共卫生机构丧失公信力。
 
一旦公信力丧失,公众就会质疑甚至无视其发布的其他风险信息,进而造成重大公共卫生危害。”以去年媒体报道的美国肺病为例,当时已有研究证实,导致此事件的原因是使用了非法添加THC(四氢大麻酚,一种从工业大麻中提取的高浓度化学物质)成分的黑市烟油,与正规电子烟无关。
 
CDC美国疾控中心却一度无视研究结论,将病因归咎于普通电子烟,直到今年3月才更正相关信息。作者认为,这种做法看似在保护消费者,实则弊大于利:“不仅让已经改用电子烟的烟民重新吸烟,也没有让大家避免真正的罪魁祸首——黑市THC产品”。
 
公共卫生伦理框架指出,实现公共卫生目标,理应使用限制性最少的干预措施。就烟草减害目标而言,为烟民提供电子烟的限制比禁售电子烟以及所有烟草制品限制更少,因此符合其伦理需求。
 
此外,为烟民提供电子烟产品及电子烟减害信息,还可为弱势群体提供更便宜的减害方案,减少社会健康差距,促进社会正义。
 
据世界卫生组织数据,烟草每年造成超过800万人死亡,烟草减害势在必行。“大量证据表明电子烟比卷烟危害小得多,公共卫生伦理框架和生物医学伦理框架均证明电子烟可用性符合伦理,是一项有益举措,因此应鼓励烟民改用电子烟。”论文指出。
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