Wednesday, June 1, 2011

Should pregnant women be banned from smoking?

In several recent posts, Dan Kuehn advanced the notion that "the future" is, in some sense, an autarkic regime... Basically, that people in the future simply aren't able to trade/negotiate with us in a way that materially affects our decisions today. Future generations are thus unable to provide the normal market signals and incentives, which would impact our behaviour on matters that stand to directly impact them. (E.g. "We'll compensate you for investing in this technology today, as we'll desparately need it fifty years from now"; "Stop this activity as soon as possible, or we'll sue you for ruining our habitat"; etc).

This sparked off an interesting back-and-forth on, not only whether "autarky" was the correct term to use in this case, but also on whether characterising things in this manner significantly alters the way that we already think about making provisions for / sacrifices on behalf of future generations. For the record, I tend to agree with Bob Murphy that "autarky" isn't technically the right term to use, because it is simply the laws of physics that prevent the future from being able to trade with us. (Contrast, say, the autarkic regime of North Korea, which is physically able to trade with other nations, but has embarked upon a bizarre policy of self-sufficiency because of political and institutional settings.) However, I do think that Daniel's framing was useful because it serves to emphasise the remorseless, uni-directional march of time and how this should inform our policy decisions.

Now, I'm pretty interested in the intemporal trade-offs, as some of you might have guessed from my numerous posts on climate change and, more recently, sustainability. In that light, I left a comment under one of DK's "the-future-is-autarkic" posts... Effectively, the discussion reminded me of an Amartya Sen article that he wrote in support of smoking bans. The position that Sen took was interesting, because he partly appealed to the ethical distinction between a smoker's past and present self, and the inability of these two to negotiate with each other:
Unrestrained smoking is a libertarian half-way house[*]
[H]ow should we see the demands of freedom when habit-forming behaviour today restricts the freedom of the same person in the future? Once acquired, the habit of smoking is hard to kick, and it can be asked, with some plausibility, whether youthful smokers have an unqualified right to place their future selves in such bondage.
Thus, Sen was making a normative argument based on the idea that we aren't always equally "free" to make decisions when it comes to smoking. It's much easier to start the habit than it is to stop and I doubt that any plausible arguments could be made to the contrary. In the Wordsworthian sense, the young smoker is the father of the man that follows him... and yet the latter is far more constrained in his choices than the former. While certainly interesting, this is not what I want to discuss today, however -- not least because there are some very murky waters to tread when it comes to putting boundaries on personal freedom.

Here's another poser for you then: Instead of focusing on an individual smoker's freedom to do to unto themselves as they wish (consequences be damned), should pregnant women be allowed to smoke?

I ask this question after reading about a new British mother who smoked an astonishing 3,500 cigarettes during her pregnancy. This special individual not only exposed her baby to (apparently) six times the safe level of carbon monoxide, but -- surprise! -- successfully ensured that her child was borne underweight and premature. God only knows what medical surprises await this kid as the years roll by... However, I'll offer even money to anyone willing to bet on the mother's own professional prognosis:
I think it was my right and I don’t believe it was hurting Lilly. It’s making the baby use its heart on its own in the first place, so that when it comes out, it’s going to be able to do them things by itself. Where’s the proof that it’s so bad to smoke? - Charlie Wilcox, M.D. (not) and candidate for new mother of the year.

Heedless: Charlie Wilcox smoked throughout her pregnancy despite midwives warning her it could harm her baby
"I'm, like, making the baby's lungs stronger and stuff, innit."

(Source: Daily Mail via 2oceansvibe)

Is this not the most clear-cut case of a negative externality that you can imagine? Why do we -- for the most part anyway -- endorse smoking bans in public places and yet permit such direct offences to persist in the case of mother and child? Surely there is no logical consistency?

Of course, you could probably extend this argument to parent-offspring relationships in general. If secondary smoke is harmful to strangers in public places, why is it fine for parents to smoke in front of their kids in private homes? Again, there is a strong inconsistency from a purely logical perspective.

I'm interested to hear the libertarian take on this. Is the simple libertarian answer that the child would sue her mother for health ailments, emotional suffering, etc once she reaches the requisite age? [Side note: Does anyone know of such a case?] More plausibly, perhaps children are expected to negotiate with their parents about where and when they smoke in each other's company? (I say "plausible", but that still leaves the uncomfortable period when the toddler or young child is powerless to negotiate on anything resembling equal terms.)

Two caveats before any comments:
  1. This is meant to be a thought exercise more than anything else. I'm not making any claims on the practicalities of policing the smoking activities of pregnant women. I'm simply interested in normative ethics at present.
  2. Yes, I am discussing a particularly reckless type of parent here. I know that most people are inestimably more responsible than dear Ms Wilcox above. However, I've seen enough pregnant women smoking to know that it happens... Say nothing of smoking in the direct presence of toddlers, which is far more widespread. The point here isn't to examine what most sensible and loving parents would likely do, but to think about how we can best protect kids that are marginalised by the stupid behaviour of their parents. 

[*] Those of you who can't access the original Financial Times article, can read (most of) Sen's text of here.


  1. I think the parent-child relationship is one of the most important areas where this issue comes up. Children are completely beholden to their parents in all kinds of ways, and again we have this problem that the childrens' future selves - who bear the costs - are unable to transact with parents. Education is a great example to start with (because your example here is so stark). A childs' education is essentially up to the parents, and by the time the child enters the workforce they can't change that initial, essential human capital investment. This provides a strong case for the public provision of education - since future-selves of children can't force their parents to properly educate past-selves of children, it's reasonable for the state to provide some basic minimum of education that parents must furnish their children with. Any additional investments are, of course, discretionary. That's a major reason why we support public education, after all - because education is good for children and they don't have the resources to provide it for themselves.

    So the logic, I think, is very sound.

    This smoking issue is tough, though. Providing education to children is one thing. You could provide health advice and services for young mothers too. But forcing them to change their behavior is a lot harder to swallow. But that's the whole problem - when there's no prospect for a transaction you have two competing utility functions (the mom's and the baby's) and no way to arbitrate it.

    In the United States, you can have your kids taken away from your for abuse or neglect if you expose them to dangers or drug use. I would think that rather than making some kind of blanket ban, it would be best to just consider pursuing these cases on a case by case basis as cases of abuse and neglect. If the mother's doctor knew she was doing this, for example, I would think the doctor should be just as obligated to report it as a case of abuse as in any other circumstance where there is evidence of abuse.

  2. Ya, I'm with you on a lot of those points and actually thought a bit about schooling whilst writing this post. As, I've said elsewhere (quite possibly on your blog) the provision of public education may be the one aspect of "welfarism" that I unreservedly support. The Nordic system that I've been exposed to recently is really phenomenal in the way that it offers the best possible education to each and every child, regardless of the material circumstances of their parents. Of course, there other institutional aspects that make their education system so interesting; not least of all the way in which they integrate public sponsorship with local competition and oversight (e.g. school vouchers).

    Coming back to parental smoking, however, I don't think that there's an argument to be made along the lines of "we can't change someone's behaviour" -- at least not from a purely philosophical perspective. That is what addressing all externalities are about after all; making someone change their behaviour on the basis that it is impacting someone else without fair possibility of compensation. You can dispute how much smoking is permissible, but in an absolute sense I don't think the parent would have a leg to stand on. My own stance would also be to err on the side of caution, as far as the child's well-being is concerned (an extension of the "first do no harm" mantra, if you will...)

    Of course, this was more meant as philosophical question than anything else, but I agree that health service advice will likely be more cost effective (and even effective, period) than any kind of blanket ban... Buttressed, as you say, by the possibility for social services to remove kids from extremely negligent cases of parenting.

  3. An additional thought quickly... Part of the reason that I wrote this post was because we typically see a big deal made about smoking bans in public areas, but there's no equivalent debate regarding this, arguably much more egregious case (i.e. pregnant mothers, or even young kids that are constantly exposed to secondary smoke from parents). It just seems strange to me that indignation is the most powerful response we can muster in such situations.

  4. This isn't really my area of expertise, but I recall there being more than "indignation" at stake when images of that toddler in Indonesia were released last year, showing him smoking 40-a-day:

  5. Indignation. Outrage.

    Tomato. Tomahto.


    Good reminder though, Dave. I remember the furore those images (and the accompanying video clip) created last year. In fact, just doing a bit of Googling, I see the kid managed to kick the habit thanks to a two-month a rehab session (not funded by the parents, of course).

    Side note: We're veering from the specific subject of this post, but there are obviously some parallels that you can draw with a number of addictive behaviours that develop (at least partly) as a result of negligent parenting skills... Obesity, etc.

  6. My take is: Pregnant women should be allowed to smoke. Many mothers are also extremely unhealthy (in both body and mind), which may be just as bad, if not worse, for the development of the foetus. For instance, the combo of a healthy diet and smoking may be better for a developing foetus than an unhealthy diet of a non-smoker. By banning pregnant women from smoking, to achieve your goals of giving all developing foetus' an equal advantage you would eventually need to enforce a certain lifestyle over all child-bearing (or potential conceiving) women. From my perspective as a libertarian, this is unacceptable. The costs of setting up a network to regulate this in millions of private homes would far outweigh the benefits.

  7. Chris, thanks for your thoughts.

    My problem with your position is that you are arguing your case via a sort of guilt-by-association. You're effectively saying that we can't control for every risk so let's insure for none -- which strikes me as most unsatisfactory. Given my aversion to absolutist approaches, I would also simply say that you pick your battles... So, while there are many measures of the relative (un)fitness for motherhood, some cases are far more clearly defined than others.

    Having said that, again, I certainly don't claim that it would be cost-effective to implement a massive regulatory scheme to monitor the behaviour of individual mothers. As mentioned above, I agree with Daniel that child services and educational programmes would yield better results. (Although, these programmes too would entail some kind of public form of provision...)

  8. Point is meddling in people's lives through the state apparatus with force and violence is right on the road to totalitarianism.

    If you want to ban pregnant women from smoking, do it to those women you can control and influence like your own wife/girlfriend/daughters/friends. Make laws in your own home. Don't make blanket laws to control everyone through the state.

    If you want to educate people about the risks, do it with your own money, not everyone else's.

    On your question on how mother/children would deal with the damage done by smoking, I don't know, I suppose to sue would be possible, if the child would want to destroy the mother/child relationship forever...

    I say what the hell, bring back eugenics...

  9. "right on the road to totalitarianism"
    "I say what the hell, bring back eugenics..."

    My God, why is everything a slippery slope for you? Is it really impossible to see the distinction between legislation that protects the health of children versus eradicating unwanted groups from the human race?

    Look, all of life is coercion and force, whether private or public, explicit or circumstantial. (What do you think a property rights regime is?) In this particular case, a mother is coercively harming her child without the possibility of legitimate compensation on reasonable terms. It isn't hypothetical, it isn't unrealistic. It HAPPENS. My question is how we, as a society, can best respond to this problem. And, yes, I certainly think that a democratically-elected State has a role to play in this to ensure fair and equal treatment across the board.

    On that note, I'm curious: What is your take on abortion? Should people be able to decide "in their own homes" whether (and when) to carry out an abortion or not? Or do you think that the State has a role to play in deciding what the stakes are and what the relevant threshold is?

    On your question on how mother/children would deal with the damage done by smoking, I don't know, I suppose to sue would be possible, if the child would want to destroy the mother/child relationship forever...
    Yes, that's largely my point. It is an absurd option to take, as it forces the child into an untenable position after the fact.

  10. "My question is how we, as a society, can best respond to this problem."

    Mmmm, good question. How about reasoning with mothers who smoke? How about educating people about it? How about donating private funds to organisations that seek to educate mothers about this? How about persuasion rather than force?

    If everything with Chris is a "slippery slope", then everything with you "Legislation". Legislate this, legislate that.

    What about the fact the mother gave the child life itself? Does that count for anything in your grand centrally planned justice equation? Or can it simply be argued in your world that the mother gave the child life irresponsibly? Shall we ban drunken one-night stands perhaps?

  11. If everything with Chris is a "slippery slope", then everything with you "Legislation".

    This, I'm sorry, is an absolute canard.

    I've written plenty, on both this site and others, about the need to do away with overbearing regulation in sections of our society and economy. More to the point, your response is again indicative of an irrepressible tendency to conflate a singular stance for legislation in one area -- in any area! -- as a call towards totalitarianism.

    As for you suggestions (2nd para), these are entirely reasonable. Please read the caveats that I provided in the actual post, as well as several comments that I have written here in support of health education and child services.

  12. @Freeman
    "What about the fact the mother gave the child life itself? Does that count for anything in your grand centrally planned justice equation?"

    Would you use this logic in the case of child abuse? If not, how is it different?

  13. @AJ50

    Read my post on it...

  14. @stickman

    I'm sorry that you're sorry mate. But if mine is a canard then so is yours to Chris. At least Chris' concerns about remorseless legislation creep are grounded in empirical reality.

    And the point is not that you, stickman are a totalitarian, the point is that 10,000 stickmen with their well-intentioned save-the-world-from-stupidity busybodiness, all nannying about inventing clever little rules and micro bans and laws, all lumped together, create a stultifying, boring, arbitrary society with mounting compliance costs for everyone.

    You accuse us libertarians of 'absolutism' in our views, unable to entertain the nuance that you and your fellow sophisticates can. But actually, you are just as absolutist and idealist as us, because one theme that constantly pervades your analysis is that with 'good' or 'sensible' legislation we can fix our world BUT ALSO avoid legislation creep.

    What I think you need to realise (apart from the fact that banning smoking among pregnant woman is a bonkers idea) is that it's not just stickman who has good ideas to implement, it hoards of folk, and when you add it all up, you're in the cul de sac of Big Brother, and now you have to live with the mess you've been responsible for creating.

    We all have absolutes, and yours are often particularly idealist delusions.

  15. How, pray tell, is mine a canard? Did I not accurately reflect Chris's views on the subject matter? Let's just review those quotes again, shall we:

    "[M]eddling in people's lives through the state apparatus with force and violence is right on the road to totalitarianism."

    "I say what the hell, bring back eugenics..."

    Being incredulous at the above is one thing[*], but I certainly don't see how I misrepresented his -- or your -- views. Also recall that, to my great amusement, I've been labelled a "Statist" and "Marxist" among other things by you chaps before, so perhaps you can excuse my sensitivity...

    Look, much of your comment actually proves my point(s). E.g. You can't call me a "sophisticate" (tks) or whatever because I refuse to apply blanket rules to all situations... And then, in the same breath, say that I am still an absolutist!

    As for idealism... I daresay that I am as least familiar with, and influenced by, public choice theory as either of you. There's no need to lecture me on stultifying bureaucracy, as I have written much on this topic before.

    I am, however, an equal opportunity critic when it comes to both government failure and market failure.[**] Indeed, I take pride in that. This may sound patronising, but I only wish you would adopt a less blinkered approach yourself.

    Actually, having said that, perhaps I am beset by "idealist delusions"...

    [*] Legislation creep is a problem in some countries, in others not. The world as a whole is in constant flux with regard to legislation, as various societies adapt to changing needs and test different systems. Countries that are now establishing new laws now will deregulate them later, and vice versa. As Hayek apparently even understood, "The Road to Serfdom" certainly hasn't proved to be a slippery slope that awaited modern social democracies. And, if we're talking "empirical reality", then the historical record makes this abundantly clear.

    [**] Read this post if you want to get a broader sense my philosophy on market versus regulation... In particular, the paragraph before "THOUGHT FOR THE DAY".

  16. Stickman, the eugenics statement was tongue in cheek, not to be taken seriously. But lets address it. By even suggesting that it would be appropriate to legislate a law banning pregnant mothers from smoking, your core philosophy is one that is anti-choice, anti-freedom, and anti-individualism. Your proposal of social engineering is eugenics by other means.

  17. I don't buy the case for public education one bit. First of all, as an empirical matter, how many parents fail to provide their children with sufficient education? And when they do fail, is it basic education they don't provide or more advanced education?

    Furthermore, defining "education" in an economic sense rather than a technical sense means getting subjective. Every child is different. For the government to provide "basic education" may be feasible in a technical sense but not an economic one. Vast amounts of resources are going to be squandered here, including the child's time.

    Perhaps more fundamentally, if parents can't be trusted to provide for their children, surely it's ridiculous to expect the government to do so.

    Also (and this is more vague and harder to prove, so it goes last), government provision of "basic education" may not leave other functions constant. By lessening the connection between parents and children, parents may be less willing and/or less able to provide other kinds of education that children need--i.e., how to say "please" and "thank you" as opposed to how to calculate the area of a triangle.

  18. Stravinksy,

    Thanks for stopping by. I've, literally, been up all night working on my thesis, but here's my sleep-deprived response... Though it takes us even further off topic :(

    1) It's not about desire to provide children with good/equal education, it's about ability. And, yes, I do think that many parents are not able to provide their children with something resembling a decent basic education on their own. There is, of course, a whole host of negative/positive feedback loops at play here too... People aren't borne equal in any practical sense; the material circumstances of their parents matters hugely.
    2) If you're talking empirics, then you're going to have to deal with the fact that the countries that continually top international learning tables are those where government has the largest hand in the schooling system. On that note, here's an interesting article worth reading on the balance between State support for education and individual teacher responsibility/freedom to instruct.
    3) I completely agree that children are unique and that a one-size-fits-all approach would be sub-optimal. However, does public education (or even state support of schooling) have to be completely standardised? No, and, furthermore, it actually isn't. Even then, a broad-based, holistic basic education is about as reasonable offer as you're going to find in the real world. If you're going to come down on education for failure to implement perfect price discrimination then that leaves you in uncomfortable territory for basically every good or service in the economy. (I'd also say that you need to think of public and private schooling as offering a wider choice for society together...)
    4) I completely agree that schooling is not a substitute for parenting. I'm not here to defend the apathy of some people's approach to their children (something which is very hard for anyone to rectify)... Or, indeed, the false empowerment of children in certain countries that have rendered their educators all but ineffective. Call me old fashioned, but I endorse the notion of brining back some semblance of discipline to schools. (My own experiences would lead me to support a return of corporal punishment -- under strict guidelines such that punishment may only be metered out by the headmaster, etc -- but that may simply be opening a can of worms for yours truly...)

  19. Then make a topic about education so I can argue about it.

  20. Haha, gotcha.

    It will have to wait 'til next week, though. Thesis deadline in eight days!

  21. "your core philosophy is one that is anti-choice, anti-freedom, and anti-individualism."

    So the *individual* fetus has the freedom to choose not to ingest the mother's nicotine? (By the way, I think such a ban is probably a bad idea, but for pragmatic reasons: enforcement would be awful.)

    "Your proposal of social engineering is eugenics by other means."

    Utterly daft. Protecting an unborn child from smoke is eugenics?!


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