Wilson Nick, Thomson George
Department of Public Health, Wellington School of Medicine and Health Sciences, University of Otago, PO Box 7343, Wellington South, New Zealand.
Soc Sci Med. 2005 Aug;61(3):649-59. doi: 10.1016/j.socscimed.2004.11.070. Epub 2005 Jan 21.
This article aims to describe the major ethical issues surrounding tobacco taxation, and to identify policy responses to minimise any ethical dilemmas. It uses the standard ethical framework for biomedicine (covering beneficence, non-maleficence, respect for autonomy and justice), in conjunction with relevant data on tobacco taxation from various developed countries. Tobacco taxation contributes substantial benefits at the population level by protecting health (i.e., by deterring the uptake of smoking by youth, by promoting quitting, and by reducing harm from exposure to second-hand smoke (SHS)). However, tobacco taxes can contribute to financial hardship among low-socioeconomic status populations where smoking persists. Such taxes can contribute to autonomy, by reducing SHS exposure to non-smokers, and by allowing freedom from nicotine-dependency for those who quit smoking or do not start regular smoking as a result of high tobacco prices. Furthermore, increases in tobacco taxation may reduce health inequalities and so contribute to justice. Nevertheless, the additional tax burden imposed on smokers who wish to continue to smoke, or are unable to quit, can be considered unjust. The autonomy of such smokers may be partly impaired. Although tobacco tax can be regarded as ethically justifiable because of its substantial overall benefit to society, there is substantial scope for policy changes to further reduce any harms and injustices for those populations who continue to smoke.
本文旨在描述围绕烟草税收的主要伦理问题，并确定将伦理困境降至最低的政策应对措施。它运用了生物医学的标准伦理框架（涵盖行善、不伤害、尊重自主权和公正），结合来自各个发达国家的烟草税收相关数据。烟草税收通过保护健康（即通过阻止年轻人吸烟、促进戒烟以及减少二手烟暴露的危害）在人群层面带来了巨大益处。然而，烟草税会给吸烟现象仍然存在的低社会经济地位人群带来经济困难。这类税收通过减少非吸烟者接触二手烟以及让因烟草价格高昂而戒烟或未开始经常吸烟的人摆脱尼古丁依赖，从而有助于维护自主权。此外，提高烟草税可能会减少健康不平等现象，进而促进公正。然而，对那些希望继续吸烟或无法戒烟的吸烟者额外征收的税收负担可能被视为不公正。这类吸烟者的自主权可能会部分受到损害。尽管由于烟草税对社会有巨大的总体益处，可被视为在伦理上是合理的，但仍有很大的政策调整空间，以进一步减少对那些继续吸烟人群的伤害和不公正。
