The Attack on Dignity and Moral Autonomy: The Case of Cigarettes

The latest in the paternalistic actions of the federal government are a kind of reductio ad absurdum. At least this is how it might have seemed ten or fifteen years ago if someone would have said that cigarette-pack health warnings would become graphic pictures designed to horrify the public into not smoking.

What is especially interesting about this development is the subtle change in arguments over the years about the purpose of government interference in this area.

1. In the beginning we had the Surgeon General’s Report simply warning people about the health consequences of cigarette smoking. Of course people realized that cigarette smoking was harmful even before the 1962 report.
2. Then we had fairly general warnings about “hazards” to health. In fact, at first it was simply said that smoking may be hazardous to one’s health.
3. Warnings evolved to include mention of specific illnesses.

All of this is the provision of information, although with the warnings on the package itself the idea was to remind people at the moment of purchase.

Why was it perceived by some that the provision of information, even at the moment of sale, is not sufficient? Why must we move to dramatic presentation of low-probability events? (Most people who smoke do not turn out as the photographs suggest, and many people who do not smoke will have breathing tubes, feeding tubes and nasty medical procedures sometime before they die.)

There are two answers to this question. The first is the “scholarly” answer.  Behavioral economists tell us that many people exhibit “optimism bias.” This is the cognitive attribute in which the person simultaneously realizes that the probability of, say, getting ill from tobacco smoking is p but that this population frequency does not apply to him. It does not apply to him for “magical reasons.” He has good luck and so forth. So the probability of getting ill is for him (significantly?) less than p.

In view of this, some behavioral economists have suggested that policy makers use another cognitive bias – “availability bias” – to offset the optimism bias. Availability bias refers to the exaggerated fear and estimate of the probability of harm when one is confronted with, say, a plane accident or instance of terrorism. After a plane accident many people think that the probability of dying in a plane crash is much higher than a cool statistical analysis would suggest.

So now let us put the two biases together and construct a policy. Telling people that smoking is dangerous – even providing people with statistics – is not enough. They will still think that their personal good luck will save them. So we must use their availability bias. We must make the images of a horrible death so available to their minds that they are jolted out of their optimism bias.

But wait. There is evidence that smokers already think that the probability of death and illness from smoking is higher than it really is. So it is unclear what optimism bias does here. Perhaps it just offsets it? In addition, how scary should the advertising campaigns be? Theoretically, they should just be scary enough to offset the optimism bias.

Thus we need to know the effective personal probability the individual places on disease from smoking and the degree to which the scary graphic offsets that.  Bottom line: We do not have this information nor are we likely to get it soon.

The second answer follows from the practical irrelevance of the first.  The campaign of scary pictures, scenarios and the like, will be deemed successful only when cigarette smoking is reduced to an extremely low level. The “optimum” is not well-informed decisionmaking by morally autonomous agents.  It is doing what the paternalist thinks you should be doing or not doing. Case closed.

So the whole campaign is an insult to the dignity of the individual. It is an attack on the older principle of informed choice. It does not respect individual moral autonomy.  It is an example of the sickness of modern American society.