Do we have a right to harm ourselves?
by Sam
Debates over whether we have the right to harm ourselves often focus on especially serious cases, such as physician-assisted suicide. But an equally robust debate over self-harm involves ‘vice,’ such as gambling, smoking and drinking. The pendulum of American attitudes on vice has swung from extreme regulation and repression in the beginning of the 20th century, to an attitude more tolerant of free choice in today’s world. Although gambling remains high circumscribed throughout the country, alcohol is widely permitted under a scheme restrictions regarding age and location.
Smoking, on the other hand, has witnessed a different history of regulation. Once hardly encumbered by governmental interference, smoking now endures age and location prohibitions in addition to heavy taxation. Yesterday, the United States House of Representatives took a major stride in increasing government authority over smoking by approving a measure to place tobacco products under the purview of the Food and Drug Administration (FDA). While the legislation would not allow the FDA to remove nicotine from tobacco products or halt the manufacture and sale of tobacco products, it would permit federal authorities to reduce the quantities of nicotine in tobacco products and also require the removal of other potentially carcinogenic ingredients.
What does this say about the freedom to engage in what most agree is a harmful activity?
Barriers to access, such as a minimum age or prohibition of smoking indoors, generally limit just how free people are to pursue an activity. At the same time, even extreme regulation enshrines a right in a way outright prohibition cannot. Sure, smokers aren’t free to smoke in restaurants or bars, but the government cannot march into their homes and stamp out a smoldering butt.
This new legislation maintains America’s agnostic stance to smoking. Since increasing availability of scientific evidence on the detrimental effects of smoking, along with the fallout of the tobacco settlements of the late 90s, America’s official position has been “you’re free to smoke, but we’d rather you not do it and we’ll make it quite difficult.” The new bill, if it passes the senate, would increase those difficulties, but as long cigarette companies can market products that include nicotine, it still allows smoking to continue freely. The message remains, smoking is bad, but you can dig your own grave. We just won’t make it easy for you.
Whether or not this represents genuine liberty hinges on a few issues. One of the guiding principles behind American democracy is some idea of self-ownership, that we make our own choices and that our bodies – and minds – are ours with which to dispose as we please. This entails at least minimal protection through the state to prevent citizens committing wanton acts of theft, assault, or murder. It also implies protection from the state in terms of our ideas, opinions and beliefs. Physical integrity and property combined with freedom of conscience make good on this general notion of liberty as self-ownership.
Freedom to harm oneself, however, remains thorny because it’s the freedom to do things that, if someone else did them, would constitute an abridgement of one’s freedom. The debate over when self-harm might be allowed tends to focus on a few issues:
Informed consent: a person has the ability or opportunity to understand the risk he is taking. This, in part, explains many of the age restrictions applied to vice. While we may factually debate the actual age at which someone can make informed choices, age restrictions enshrine the moral assertion that a particular kind of cognizance is necessary to engage in risky or harmful behavior.
Consequences for others: a number of potentially self-harming behaviors are limited due to their effects, not on oneself, but on others. Prohibitions against smoking indoors generally reflect concerns about the health of those exposed to smoking, not that of the smoker himself.
Stakes: what is the final outcome of the risk? This seems to be the locus of the debate. Could the risky behavior result in (immediate) death? American society tends to be more tolerant of potentially self-harming behaviors that either do not result in death (gambling) or with which the connection to death appears sufficiently remote (drinking and smoking). Those with a direct connection to death – euthanasia and, to a lesser extent, organ sale – enjoy the most stringent regulations.
Consideration of the stakes, in particular, shows why the relationship between liberty, self-ownership and self-harm is not well defined. What is the difference between euthanasia and smoking? Is it the timeframe (smoking doesn’t kill right away) or the probability (euthanasia will kill you, smoking only might)? It is entirely possible that we object to one self-harming behavior and allow the other, not out of some consistent set of principles, but due to a set of perceptions regarding potential harm, whether or not they are grounded in fact.
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