United States Department of Health, Education, and Welfare

“ The principle of respect for persons thus divides into two separate moral requirements: the requirement to acknowledge autonomy and the requirement to protect those with diminished autonomy.
An autonomous person is an individual capable of deliberation about personal goals and of acting under the direction of such deliberation. To respect autonomy is to give weight to autonomous persons' considered opinions and choices while refraining from obstructing their actions unless they are clearly detrimental to others. ”

“ You may be uncertain yourself about the dangers of smoking. Still your child will want you to take a stand one way or the other. If you do not, he will wonder if you have his best interest at heart. For his sake, say to him: "No smoking for you." ”

“ To show lack of respect for an autonomous agent is to repudiate that person's considered judgments, to deny an individual the freedom to act on those considered judgments, or to withhold information necessary to make a considered judgment, when there are no compelling reasons to do so.
However, not every human being is capable of self-determination. The capacity for self-determination matures during an individual's life, and some individuals lose this capacity wholly or in part because of illness, mental disability, or circumstances that severely restrict liberty. ”

“ In balancing these different elements, the risks and benefits affecting the immediate research subject will normally carry special weight. On the other hand, interests other than those of the subject may on some occasions be sufficient by themselves to justify the risks involved in the research, so long as the subjects' rights have been protected. Beneficence thus requires that we protect against risk of harm to subjects and also that we be concerned about the loss of the substantial benefits that might be gained from research. ”

“ Assessment of Risks and Benefits The assessment of risks and benefits requires a careful arrayal of relevant data, including, in some cases, alternative ways of obtaining the benefits sought in the research. Thus, the assessment presents both an opportunity and a responsibility to gather systematic and comprehensive information about proposed research. For the investigator, it is a means to examine whether the proposed research is properly designed. For a review committee, it is a method for determining whether the risks that will be presented to subjects are justified. ”

“ Tell them that you hope they will never get themselves in such a fix. Tell them that when you started to smoke you didn't have the facts that you now have; that it is possible you have cut off years of life by your own smoking. ”

“ And for some time, their worries about their children who are already smoking, or their fears that they may take it up, have been increasing.
SMOKING AND HEALTH leaves no doubt that the person—the man, woman, boy, girl—who smokes is already on a road to possible disability and an earlier death.
SMOKING AND HEALTH is written in medical terms. In day-to-day language, it says:
If your child smokes cigarettes, chances are much greater that he will die of lung cancer, or chronic bronchitis, or emphysema (serious lung disease) , or coronary heart disease. ”

“ When research is proposed that involves risks and does not include a therapeutic component, other less burdened classes of persons should be called upon first to accept these risks of research, except where the research is directly related to the specific conditions of the class involved. Also, even though public funds for research may often flow in the same directions as public funds for health care, it seems unfair that populations dependent on public health care constitute a pool of preferred research subjects if more advantaged populations are likely to be the recipients of the benefits. ”

“ Always consider and discuss patiently with your child any opinion he has about smoking. Many parents have found that admitting that their pro-smoking son or daughter has a point—even to agreeing that to many smokers smoking is everything claimed for it—has proved a sound base from which to start again—calmly and rationally—to consider the problem. ”

“ Injustice may appear in the selection of subjects, even if individual subjects are selected fairly by investigators and treated fairly in the course of research. Thus injustice arises from social, racial, sexual and cultural biases institutionalized in society. Thus, even if individual researchers are treating their research subjects fairly, and even if IRBs are taking care to assure that subjects are selected fairly within a particular institution, unjust social patterns may nevertheless appear in the overall distribution of the burdens and benefits of research. ”

“ The Hippocratic maxim "do no harm" has long been a fundamental principle of medical ethics. Claude Bernard extended it to the realm of research, saying that one should not injure one person regardless of the benefits that might come to others. However, even avoiding harm requires learning what is harmful; and, in the process of obtaining this information, persons may be exposed to risk of harm. ”

“ The earlier your boy or girl starts cigarette smoking, the greater the chances are that he will become a heavy smoker and develop the habit of inhaling, which further increases the risk of early disability and a shortened life. The longer your child puts off starting smoking or the sooner he can break the habit, the greater his chances are of avoiding that fate. ”

“ Unjustifiable pressures usually occur when persons in positions of authority or commanding influence -- especially where possible sanctions are involved — urge a course of action for a subject. A continuum of such influencing factors exists, however, and it is impossible to state precisely where justifiable persuasion ends and undue influence begins. But undue influence would include actions such as manipulating a person's choice through the controlling influence of a close relative and threatening to withdraw health services to which an individual would otherwise be entitle. ”

“ It is unlikely that these steps will be successful unless the child is convinced and makes up his own mind.
For a long time every young girl and boy has seen people around him smoking. He has heard a steady sales talk about the pleasures and advantages of cigarettes, from people close at hand as well as from the radio, TV, newspapers, magazines, billboards. If his parents present only the anti-smoking side, he may think that they are not being honest with him.
He has often heard and believes many pro-cigarette arguments. For instance:
Smoking helps the smoker concentrate. ”

“ Boundaries Between Practice & Research It is important to distinguish between biomedical and behavioral research, on the one hand, and the practice of accepted therapy on the other, in order to know what activities ought to undergo review for the protection of human subjects of research. ”

“ Say that it is so hard to give up cigarettes that that in itself is one good argument for never starting smoking.
Along with the words, make as strong an effort as possible to at least cut down on the number of cigarettes you smoke. Try to stop inhaling so much and so deeply.
If you make a bargain with your child about his not smoking or your not smoking, never break your end of it.
Many parents, who are continuing to smoke cigarettes, try not to smoke before their young children. ”

“ But the role of the principle of beneficence is not always so unambiguous. A difficult ethical problem remains, for example, about research that presents more than minimal risk without immediate prospect of direct benefit to the children involved. Some have argued that such research is inadmissible, while others have pointed out that this limit would rule out much research promising great benefit to children in the future. ”

“ That means you have to convince him that the attitudes, beliefs, and behavior you offer are better.
So, again, be considerate and careful. You might humiliate, hurt, and insult him. That is the last thing in the world that you would want to do. Should you belittle his thoughts, you won't get to first base, and can't blame him if he hates and resists your ideas. ”

“ One standard frequently invoked in medical practice, namely the information commonly provided by practitioners in the field or in the locale, is inadequate since research takes place precisely when a common understanding does not exist. ”

“ Sometimes—because of the nature of most of us—we seek and take advice from persons other than the ones closest to us. So don't be surprised if your child does that. Such action is no reflection on you. Many teenagers don't take advice from their parents, regardless of how much they respect them.
Encourage your child—before he decides to smoke or not smoke—to talk with his doctor, his minister, his teacher, the public health nurse, or anyone else he respects and who will give him sound advice.
A FEW PARTING WORDS
Many teenagers are choosing not to smoke. ”

“ Some persons are in need of extensive protection, even to the point of excluding them from activities which may harm them; other persons require little protection beyond making sure they undertake activities freely and with awareness of possible adverse consequence. The extent of protection afforded should depend upon the risk of harm and the likelihood of benefit. The judgment that any individual lacks autonomy should be periodically reevaluated and will vary in different situations. ”

“ The best time to start the "man to man" teaching about smoking may be about the seventh grade; that is, when the child is getting into the teens. Studies show that that is the time most children really begin to consider seriously taking up the habit. ”

“ In the case of particular projects, investigators and members of their institutions are obliged to give forethought to the maximization of benefits and the reduction of risk that might occur from the research investigation. In the case of scientific research in general, members of the larger society are obliged to recognize the longer term benefits and risks that may result from the improvement of knowledge and from the development of novel medical, psychotherapeutic, and social procedures. ”

“ Further, the Hippocratic Oath requires physicians to benefit their patients "according to their best judgment." Learning what will in fact benefit may require exposing persons to risk. The problem posed by these imperatives is to decide when it is justifiable to seek certain benefits despite the risks involved, and when the benefits should be foregone because of the risks.
The obligations of beneficence affect both individual investigators and society at large, because they extend both to particular research projects and to the entire enterprise of research. ”

“ In family talk from time to time, ease in the idea that to be independent, to follow one's own private beliefs, and not "go with the herd" takes great strength.
And then there are the teenagers who say: "I really feel I'm 'in' when I smoke. Each puff sends rules of home and school to blazes." ”

“ Finally, whenever research supported by public funds leads to the development of therapeutic devices and procedures, justice demands both that these not provide advantages only to those who can afford them and that such research should not unduly involve persons from groups unlikely to be among the beneficiaries of subsequent applications of the research. ”

“ Although individual institutions or investigators may not be able to resolve a problem that is pervasive in their social setting, they can consider distributive justice in selecting research subjects. ”