Are we responsible for each other's health?

In his regular column, Dr Graham Haydon argues that the decision to smoke is not just a matter of individual choice.

In Scotland the law now prohibits smoking in public places including bars and restaurants. It seems likely that similar laws will follow in England and Wales before long. There are several issues here for both PSHE and citizenship.

PSHE, especially where health issues are concerned, tends to put the emphasis on informed choice. We like to see young people as responsible for their own health-related choices. The responsibility of the teacher is not to make people’s choices for them, but to try to see that the choices they make rest on understanding the likely consequences of one decision or another.

There is, of course, a lot to be said for this approach. For one thing, on a practical level, it is simply not possible to determine in detail how other people are going to behave. On a more ethical level, the policy of enabling people to make their own choices and then treating them as responsible for their own health expresses an underlying value of respect for people. But is it really the most ethical policy?

Ethical decision-making

When we encourage people to take responsibility for their own health-related decisions, we encourage them to look after themselves. That seems right; but might it be one (unintended) consequence of such a policy that people do not pay enough attention to the consequences that their actions have for others? Being a responsible person is not only about looking after oneself, but also about taking responsibility for the consequences of one’s actions for other people. Moral and social responsibility was one of the primary strands of citizenship identified in the Crick report, which led to the introduction of citizenship in the national curriculum.

Respect for people (which in philosophical ethics is associated with Kant) is not just about leaving people to look after themselves. We have to take account of other people’s vulnerabilities; so our respect for other people’s choices has to be supplemented by taking the consequences for other people into account when we make our decisions. This is the ‘consequentialist’ or ‘utilitarian’ strand in ethics associated with John Stuart Mill. (Many textbooks on ethics see Kant and Mill as radically opposed to each other; actually they have quite a lot in common.) So let’s look at the consequences for other people of a person choosing to smoke.

Three kinds of consequence

Mill was very much opposed to the State telling people what to do for their own good. He thought the State, and public opinion, should not interfere with people living their lives the way they want unless interfering is the only way to prevent harm to others. (Mill’s ‘harm principle’, which puts a limit on what we should tolerate) We now know, as Mill in Victorian times did not, that passive smoking is harmful. That already gives us one ground for limiting people’s freedom to make their own choice about smoking.

The arguments for a ban on smoking in public tend to focus on the direct harm caused by passive smoking. But we shouldn’t forget (especially in an educational context) a second kind of consequence: the example that one person’s action sets to another. The following situation illustrates an important point about taking responsibility for our actions: we have to take into account how our actions will be interpreted by others.

Setting an example

Near my home there is a three-way road junction controlled by traffic lights, with the pedestrian crossing light coming on only at a certain point in the sequence. I am very familiar with the sequence, and I can look around in three directions. I often cross without waiting for the pedestrian light. But even if I can see it, it would be safe to cross, I will wait if there are small children at the crossing. I do not want to set them a bad example. After all, the lesson they would get from seeing me crossing against the pedestrian light would not be ‘It’s all right to cross if you know the sequence and you can see that it’s safe’; it would be ‘Adults sometimes cross against the lights so why shouldn’t I?’

Setting an example that influences another person to do something that is bad for them might by itself have bad consequences for that one person. But when we take into account the totality of all the individual decisions that every person makes – to take up smoking or not, to light up in public or not – we have a third kind of consequence that is harder than ever to pin down but perhaps the most far-reaching of all: gradually, there can be a whole culture change. What used to be ‘what everyone does’ becomes something that most people don’t do. Smoking used to be the norm; now (or if not now in some parts of the country, then pretty soon) not smoking becomes the norm.

Despite the idea that we should each, responsibly, make our own decisions, very few of us are immune from the tendency to do what most people do. And this is not necessarily a bad thing. It depends on the exact nature of what most people do. That is why the nature of the surrounding culture is so important. The UK government has recognised this in some of its recent policies. Whatever one thinks, for instance, of the government’s ‘respect agenda’, the aim of creating ‘a culture of respect’ is on the right lines. So is the aim, I would argue, of trying to create a non-smoking culture.

Useful websites

Action on Smoking and Health www.ash.org.uk
Drugscope www.drugscope.org.uk
Schools Health Education Unit www.sheu.org.uk
Teachers Advisory Committee on Alcohol and Drug Education www.tacade.com
TheSite.org www.thesite.org
Up2You www.up-2-you.net
Wired for Health www.wiredforhealth.gov.uk

Dr Graham Haydon is Course Leader, MA in Values in Education, Institute of Education

This article first appeared in – May 2006

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