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The reasons for the lack of behavioral change are many and complex (U. Major ethical issues related to smoking and other tobacco use are: (1) the protection of nonsmokers from the effects of ETS; (2) the protection of children from an addictive product; (3) the scientific integrity of tobacco industry research; and (4) corporate integrity in marketing tobacco products.In the past ethical arguments about smoking focused on issues of autonomy, paternalism, and societal harm.
From the time when the native peoples of the Americas introduced Europeans to tobacco until the second decade of the twentieth century smoking and other forms of tobacco use focused on questions of production, commerce, and morality rather than on questions of medicine (U. Medical questions about tobacco use did not materialize because until the 1920s there were no scientific grounds for supposing that smoking endangers the health of smokers.
The first public policy issues concerning tobacco centered on its role as an important cash crop and a potential source of tax revenue.
For example, in 1992 the Joint Commission on the Accreditation of Health Care Organizations (JCAHO), the chief hospital accreditation agency in the United States, required hospitals to forbid smoking within their premises by 1994 as a condition of accreditation (Center for Disease Control Chronology of Significant Developments).
Robert Goodin (1989) used these considerations to develop a vigorous case for a public policy aimed at a total ban on smoking.
Smoking as an individual choice was juxtaposed against the restriction of individual smoking behavior as a consideration in protecting the individual from himself or herself and protecting society from smokers.
Today the moral issues associated with tobacco use have moved away from individual autonomy and individual values because of the recognition of the significant public health implications of smoking.
Today bans on smoking in public places are common and often complement state tobacco control programs that have been shown to be effective, at least in one instance, in reducing the mortality from heart disease attributed to smoking (Fichtenberg and Glantz).
Restrictive social policies that attempt to protect an individual from harming himself or herself have been viewed as paternalistic.
Scientists began to build the case for the dangers of smoking when A. Broders (1920) published an article correlating tobacco use with lip cancer.
Subsequent studies repeatedly linked tobacco use, in particular smoking, with a variety of diseases, primarily lung cancer and respiratory diseases. Since 1964 a wealth of research has demonstrated the deleterious effects of tobacco use on health.