Cigarette Smoking-Our Obligation to End it Overrides Our Right to Continue it.

A 2008 issue of "Morbidity And Mortality Weekly Report", a well respected publication from "The Centers For Disease Control And Prevention" states: "Cigarette smoking and exposure to tobacco smoke are associated with premature death from chronic diseases, economic losses to society, and substantial burden on the United States health-care system. Smoking is the primary causal factor for at least 30% of all cancer deaths, for nearly 80% of deaths from chronic obstructive pulmonary disease, and for early cardiovascular disease and deaths". A 2009 issue states: "Exposure to secondhand smoke has immediate adverse cardiovascular effects, and prolonged exposure can cause coronary heart disease. Nine studies have reported that laws making indoor work places and public places smoke-free were associated with rapid, sizeable reductions in hospitalizations for acute myocardial infarction (heart attack)". These statements confirm what all of us know is true: that cigarette smoking is a profound scourge-- essentially a fatal disease that causes untold suffering, lost productivity, and incalculable expense to society. It is, of course, "legal" to smoke cigarettes, and it remains one's "right" to do so. But, it is ethically WRONG to smoke cigarettes, to manufacture them, to sell them, and to facilitate the use of them. Why are all these wrong? The answer is readily apparent when one considers the difference between the concept of "rights" and the concept of "obligations". When one considers only "rights", there are always moral conundrums and ethical dead ends. On the other hand, when one considers "obligations", there result no such restrictions. One becomes truly free "to do the right thing". Examples: I have the right to be an inconsiderate jerk; but, I have the obligation to be a decent, caring person. I have the right to be prejudiced; but I have the obligation to be tolerant. I have the right to be greedy and selfish; but I have the obligation to give to others. When it comes to cigarettes, I may have the right to smoke; but I also have the obligation to be as healthy as possible, and to promote the health of others as well. "Rights" have their origin in secular societal law, and are inherently limited; whereas "obligations" derive from sacred ethical and moral codes that are universal to humanity. We should remind ourselves that the Judeo-Christian heritage speaks only of obligations, not rights. The Bible mentions not a single right; but it does speak of several hundred obligations, both explicit and implied. Talmudic law makes it clear that all of us have the obligation to promote a healthy, peaceful, tolerant, and just society. Again, there is no discussion of "rights", only "obligations". Remember, its the "Ten Commandments" (ie obligations), not the "Ten Rights". It follows, therefore, that there is no justification to smoke cigarettes or to facilitate smoking. There IS every obligation to try to end this harmful practice. The "right to smoke" is a non-sequitur. Shame on those who cling to this "right" in the face of so much cigarette-induced devastation. As a physician whose role it is to inform patients what the best current medical science recommends to promote optimal health, to reverse disease, and to help smokers quit; I often present to them these three intellectual scenarios: 1) How would you feel if someone on the street beat you up and took your money? Well, that is what the people who make and sell cigarettes do to you. Do not let them do it. Fight back. Quit!! 2) Smoking-- including passive second-hand inhalation-- is essentially a fatal disease. {It causes lung cancer, head and neck cancers, including of the tongue and throat (truly misery to the maxx), esophageal cancer, bladder cancer, heart attacks, strokes, peripheral arterial disease, every chronic lung disease, including emphysema and asthma. It causes or contributes to other serious diseases as well.} But, it is one of the few fatal diseases for which we have the perfect cure: one that makes you look and feel better-- and puts money in your pocket. Imagine if a cancer patient had the option of a cure that involved only to quit a single noxious habit. No surgery, no chemotherapy, no radiation therapy, no expenses. Would that patient not jump at such a option? Of course! Well, you, a smoker, have it. Just quit! 3) The best scenario, however, is this one: Just declare to yourself and program your brain that you are now a healthy person. As psychology and personal achievement science have proven, the mind cannot hold at once two disparate thoughts. A mind programmed to be healthy cannot handle the thought to smoke. It is just too incongruous. Therefore, once programmed as healthy, you must and will quit. There are now available several medications that will attenuate both the desire to smoke as well as the symptoms of nicotine withdrawal. There are self-help and group programs readily available. Take advantage of them. Consult your physician about these. Admittedly, it is not easy to quit smoking. But it is the healthy and ethical obligation to do so. There is no justification to continue to smoke or to promote the "right" to smoke. The obligation to promote health must always be paramount, both for the individual and for society at large. Eli Goodman, MD

(This piece appeared originally in April 2009 as an opinion piece for the editorial pages of "The Hawk Eye," Burlington, Iowa's daily newspaper. I wrote it shortly after the Iowa legislature banned smoking in restaurants, bars, and other public places-- to counter those who criticized this legislation as an assault on the rights and freedoms of individuals and businesses to carry on as they choose.)

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