E-cigarette Ethics: The Precautionary Principle and Harm Reduction As a Basis for an E-Cigarette Ban

The regulation of e-cigarettes and the e-liquids they deliver has proved challenging for the US Food and Drug Administration given the relatively short time these products have been widely distributed and the inconclusive data about their effects on human health. While conventional tobacco cigarette use continues to drop among adults and teenagers, e-cigarette use has skyrocketed, particularly among school aged children and young adults.

Neither e-cigarettes nor e-liquids have been subject to the same (or analogous) regulation as cigarettes at the federal level and both remain legal for purchase with only minimal restrictions in most of the United States. Public health ethicists have taken positions both in favor of and opposed to such regulation, focusing on whether e-cigarettes will result in the “re-normalization” of smoking (Fairchild, Bayer and Colgrove, 2014). Many tobacco researchers have heralded e-cigarettes as a smoking cessation and harm reduction tool. While harm reduction would seem to advocate regulatory tolerance of e-cigarettes in view of the known toxicity of smoking, both public health ethicists and tobacco researchers miss the point of harm reduction by ignoring the precautionary principle (PP).

The precautionary principle requires a public health approach to see e-cigarettes and e-liquids in themselves, not merely as cigarettes with an ‘e’. E-cigarettes and e-liquids are, if one strips away the name and association to tobacco, novel but unstandardized electronic products and provocative dietary supplements or cosmetics about which there is already considerable debate about safety. Further, the ethics of harm reduction also points to a ban until conclusive data exists regarding e-cigarettes relative and overall safety, not only as a tobacco delivery device but relative to toxicity risks in themselves. Only when e-cigarettes and e-liquids have been quantified and conclusively determined to be less than that of conventional cigarettes, akin to other harm reduction strategies relative to the harm at stake (e.g., needle exchange programs for heroin), can harm reduction be used as an ethical justification for allowing e-cigarettes on the market. Until then, the FDA also has a responsibility to protect the public from e-cigarettes and e-liquids on a precautionary and harm reduction basis.