Secondhand Smoke, Moral Sanctions, and How We Should Respond to COVID-19

The country is opening up. There is much debate about whether it’s premature. We’ll see, won’t we. There is also debate about wearing masks (when and where) and social distancing (how many people is too many; how far apart should they be). Some of this debate is about what the science tells us. But some of it is ideological: how much can the government tell us about what to do with our bodies and who to do it with. Commitments to individual liberty clash with concerns about safety; freedom clashes with responsibility. How should we as a society respond to this challenge?

We can learn some lessons from the not-too-distant past. I know that young people may find this unbelievable, but when I went to college, I smoked in class. So did my professors. When I became a professor, I joined them, using the chalk tray as an ashtray. When I played in bridge tournaments, the smoke was so thick you could barely see the cards on the table. People lit up in restaurants, smoking with their coffee, between courses, and even between bites. If you found the smell of smoke distasteful, or had asthma, you might timorously approach a smoker at an adjacent table and ask, meekly, whether they’d mind blowing their smoke in another direction. There was no uncertainty, even then, about the health effects of smoking. But people had rights. We seemed to agree that people have the right to be stupid. It’s my body and I’ll die if I want to!

There was no uncertainty, even then, about the health effects of smoking. But people had rights. We seemed to agree that people have the right to be stupid. It’s my body and I’ll die if I want to!

How did we get from that day to this one, with widespread smoking bans in public places? The answer, I believe, was the discovery of the effects of secondhand smoke. When I smoked, it harmed innocent bystanders. It harmed children, including my own. The research on secondhand smoke began in the 1960s, showing negative effects on lab animals. As the work continued, it left no doubt that secondhand smoke contributes to asthma, cardiovascular disease, many types of cancer, stroke, cognitive impairment, and countless other maladies. These sorts of findings empowered people to demand, not request, that others put out their cigarettes. The secondhand smoke research led eventually to all the regulation that we now take for granted.

Why did this research change public attitudes and change them so fast—in a single generation? The answer, I think, is that research on secondhand smoke took an individual (perhaps foolish) choice and moralized it, by emphasizing its effects on others. It was no longer simply dumb to smoke; it was immoral. And that changed everything.

Psychologist Paul Rozin has studied the process of moralization. When activities get moralized, they move from being matters of individual discretion to being matters of obligation. Smoking went from being an individual consumer decision to being a transgression. And the process of moralization can go in the other direction, as we have seen, for most people, in the case of sexuality. In recent years, homosexuality has been “demoralized,” and moral sanctions against it have slowly been melting away.

Research on secondhand smoke took an individual (perhaps foolish) choice and moralized it, by emphasizing its effects on others. It was no longer simply dumb to smoke; it was immoral. And that changed everything.

Another example of moralization occurred with regard to drinking and driving. People used to regard it as funny, as devil-may-care, even as macho to get behind the wheel after an evening at a bar or a party. As with smoking, drinking and driving may be stupid, but we don’t prohibit people from doing stupid things. Then, in 1980, Candace Lightner responded to her 13-year-old daughter’s death at the hands of a drunken, hit-and-run driver by establishing MADD, Mothers Against Drunk Driving. And that changed everything: designated drivers, car keys in a basket, serious legal penalties for DUI. MADD did for drunk driving what the secondhand smoke research did for smoking: it turned something merely dumb into something immoral.

I think we can learn a valuable lesson for the present moment from the examples of smoking and drunk driving. We are, as a society, reluctant to tell people how to live their lives, except insofar as individual decisions affect the lives of others. Anything we do that affects others has a significant moral dimension, and under these circumstances, our fellow citizens and our public institutions have the right—perhaps even the responsibility—to limit what to do. “Don’t get so close to me!” “Put on a damn mask!” “Your right to swing your arms around stops at my chin!”

It should have been obvious from the start that smoking and drunk driving have effects on others. But almost everything we do has effects on others, and we aren’t about to tell people, in molecular detail, how to live their lives. Yet, smoking and drunk driving have life and death effects on others. That makes a difference. We feel entitled to tell people what to do. Well, so does COVID-19. That’s why they call it “infectious” disease.

Smoking and drunk driving have life and death effects on others. That makes a difference. We feel entitled to tell people what to do. Well, so does COVID-19.

My own reading of the public health messages being offered as society opens up is that they have been too much focused on the effects of our behavior on us, and not enough focused on the effects of our behavior on others. Moralizing how we behave as we come out of social and economic isolation may go a long way toward inducing people to behave responsibly and empowering the people around them to demand that they behave responsibly. So, let us analogize high-risk behavior in the face of COVID-19 to smoking in restaurants and driving while drunk. Moral sanctions have powerful effects on behavior. Let’s see if we can use them to rein in recklessness in the face of a pandemic.