Jarvie and Malone Respond

Desapriya et al. make several important points about the dangers of smoking in cars, particularly regarding the risks to nonsmokers; we agree that it is preferable that people not smoke in cars. However, our article examined the ethical principles under which policy intervention in this area would be justifiable. Our analysis showed that banning smoking in cars carrying children is ethically justifiable because children are not fully autonomous; thus, they are unable to act to protect their own interests. The same argument might be applied in situations where women are not fully autonomous because of social, economic, cultural, or other constraints. In such cases, they would be unwillingly exposed to potentially life-threatening toxins, and this would be ethically unjustifiable. Still, from an ethical perspective, a complete ban on smoking in cars based solely on disease risks to individual smokers and autonomous nonsmokers is ethically untenable. This would, in our view, represent an infringement on their autonomy that the principle of beneficence probably could not justify. Nevertheless, Desapriya et al.'s mention of distracted driving calls attention to a possibly useful parallel case. Because smoking, like using a cell phone, is considered a driver distraction,1 a ban on smoking while driving might be justified on the basis that this infringement on individual liberty is warranted to protect the general public from the harmful consequences of distracted-driver collisions. This still may not ethically justify a complete ban on smoking in cars, however, as the justification would apply only to drivers—unless smoking adult passengers were also shown to cause distracted driving, which seems less plausible. Desapriya et al.'s other useful idea is altering cars so lighters and ashtrays are no longer standard vehicle features. This would remove a visual cue to smoke and denormalize smoking as an activity appropriate while driving, similar to the effects of making public spaces smoke free. Many modern cars are not automatically equipped with ashtrays, so this may already be happening. Ethically, taking such a measure would represent less intrusion on autonomy than a complete ban. Finally, Desapriya et al.'s idea of making cars with devices that would disable them if smoke was detected is interesting, but unless the smoke itself distracted drivers or otherwise created risks from which autonomous adults could not protect themselves, we are unconvinced that this rather intrusive measure would be ethically justifiable under the framework we discussed in our article

History · Medicine · Risk Perception and Management · Gerontology

• Global and regional burden of disease and risk factors, 2001

  Open Access•Alan D Lopez, Clay Mathers et al.•The Lancet•2006

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• Political dynamics promoting the incremental regulation of secondhand smoke

  Open Access•Katherine Bryan-Jones, Simon Chapman•BMC Public Health•2006

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• Children's Secondhand Smoke Exposure in Private Homes and Cars

  Jill A Jarvie, Ruth E Malone•American Journal of Public Health•2008

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