Table 1 Ethical considerations surrounding the availability and use of e-cigarettes
From: Ethical considerations of e-cigarette use for tobacco harm reduction
Ethical considerations | Supporting arguments | Opposing arguments | Questions to direct future research |
|---|---|---|---|
Tobacco harm reduction | |||
 Potential for smoking cessation | E-cigarettes may be as effective as the nicotine patch. | Inconclusive evidence of efficacy for smoking cessation. | What is the efficacy of nicotine and non-nicotine e-cigarettes for smoking cessation and reduction? |
Potential for smoking reduction | Demonstrated in multiple studies. | Unlikely that cigarette reduction results in significant health benefits. | What is the long-term impact of dual use of e-cigarettes and tobacco cigarettes on health outcomes? |
Product safety | |||
 Potential for long-term adverse effects | Unknown impact of long-term propylene glycol inhalation. | No documented serious adverse events to date. | What are the long-term safety implications of nicotine and non-nicotine e-cigarette use? |
Propylene glycol inhalation causes short-term respiratory irritation. | |||
 Autonomy to use a product of unknown risk | Ethical imperative given informed consent. | Public health concerns trump individual rights. | How should consumer rights be weighed against public health concerns? |
Use among non-smokers | |||
 Potential to lead to nicotine addiction | Perceived harmlessness may lead never smokers to initiate e-cigarettes. | No evidence for increased nicotine addiction to cause net public health harms. | What is the long-term health impact of nicotine addiction? |
 Potential gateway effect | Nicotine acts as a priming agent for the brain. | Unclear implications for transitioning to tobacco cigarettes. | How many non-smokers initiating e-cigarettes transition to other tobacco products, including cigarettes? |
Use among youth | |||
 Potential to lead to nicotine addiction | Minors require protection. | No evidence of increased nicotine addiction causing net public health harms. | How many youth initiating e-cigarettes report continuous long-term product use (1 year or longer)? |
E-liquid flavorings are attractive to youth. | |||
 Potential gateway effect | Nicotine is a priming agent for the brain. | Unclear implications for transitioning to tobacco cigarettes. | How many youth initiating e-cigarettes transition to other tobacco products, including cigarettes? |
 Nicotine poisoning among children | Increased calls to poison control centers. | None. | To what extent can the risk of nicotine poisoning among children be mitigated? |
E-liquid flavors are appealing to youth. | |||
Use in public places | |||
 Potential for passive vaping | Stem cell cytotoxicity. | Limited evidence that passive vaping poses significant health concerns. | What is the long-term impact of passive vaping and second-hand vapor exposure? |
Aerosolized nicotine emissions. | |||
Renormalized smoking culture | |||
 Potential to subvert decades of anti-smoking efforts | Increased acceptability of smoke-like vapor and smoking behavior. | No evidence that e-cigarettes would be conflated with tobacco cigarettes. | How are the increased awareness and use of e-cigarettes affecting perceptions of cigarette smoking? |
Market ownership | |||
 Unethical collaboration with the tobacco industry | Public health endorsement of e-cigarettes increases tobacco company market share. | Possible necessity to collaborate with the tobacco industry to achieve public health gains. | What are the public health implications of tobacco industry ownership of major e-cigarette brands? |