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Tobacco endgame strategies: challenges in ethics and law
  1. Bryan P Thomas,
  2. Lawrence O Gostin
  1. O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC, USA
  1. Correspondence to Dr Bryan P Thomas, O'Neill Institute for National and Global Health Law, Georgetown University Law Center, 600 New Jersey Avenue, NW, Washington, DC 20001, USA; bpt11{at}


There are complex legal and ethical tradeoffs involved in using intensified regulation to bring smoking prevalence to near-zero levels. The authors explore these tradeoffs through a lens of health justice, paying particular attention to the potential impact on vulnerable populations. The ethical tradeoffs explored include the charge that heavy regulation is paternalistic; the potentially regressive impact of heavily taxing a product consumed disproportionately by the poor; the simple loss of enjoyment to heavily addicted smokers; the health risks posed by, for example, regulating nicotine content in cigarettes—where doing so leads to increased consumption. Turning to legalistic concerns, the authors explore whether endgame strategies constitute a form of ‘regulatory taking’; whether endgame strategies can be squared with global trade/investment laws; whether free speech rights are infringed by aggressive restrictions on the advertisement and marketing of cigarettes.

  • End game
  • Socioeconomic status
  • Prevention
  • Litigation
  • Disparities

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