The ethics of tobacco control: ‘good people doing good things’

A richer understanding of the ethical basis for ending the tobacco epidemic has the potential to strengthen the case for change. This paper first addresses the way that the two key moral goods of well-being and freedom, elements of a ‘good life’, are limited by tobacco dependence. The limited negative view of freedom as a lack of prohibition is rejected in favour of a view of freedom as capability—what individuals can actually do. Second, arguments around tobacco control are considered through the long-established medical ethics framework of principlism—an approach that weighs decisions according to their respect for beneficence, non-maleficence, autonomy and distributive justice. The ethical responsibilities of healthcare and other organisations, as well as government, are considered, as are the ethics of the tobacco industry itself, whose products drastically limit human well-being and freedom, yet uses moral arguments to promote itself through corporate social responsibility. The enormous impact of smoking on both well-being and freedom, combined with the existence of effective means to end these harms, provides a moral imperative to pursue the tobacco endgame.