The depressing atmosphere of Australian pubs

We introduced baby Hayden to my family over dinner in a pub in Adelaide, the Grand North on Grand Junction Road. With seven young children it was a raucous affair - fortunately there were almost no other customers dining there. This is not to say that the pub didn't have patrons: we frequently saw elderly people in wheelchairs slowly cross the pub to get into the pokies room, where they would spend hours upon hours staring at a machine and dribbling their pension into it. Gambling is a major issue in Australia. It is estimated that 40% of all revenue on pokies come from these "problem gamblers", who are being sucked dry by the Pokies now ubiquitous in Australian pubs. "Personal responsibility" you cry - well that is just being naive. The Pokies Industry has spent decades of research developing the most addictive games possible, with short spin times and massive maximum bet sizes, all designed to ramp up the expenditure rate on the 1% of Australians who have a gambling addiction. With billions to spend on research and development and teams of psychology experts tweaking every aspect of the games to encourage addictive behaviour, the vulnerable in society simply don't stand a chance. The modern machines are so efficient at provoking addictive behaviour that 15% of all regular players become problem gamblers.

Controlling the exponential growth in Pokies has been brewing politically for at least 15 years, when Nick Xenophon made it to the South Australian parliament in 1997 on a "No Pokies" platform. Now, with the Gillard Labor party and independents Xenophon and Wilkie in parliament, a critical mass has formed to actually do something about problem gambling. An independent committee recommended mandatory pre-commitment as a way to allow problem gamblers to control themselves. It still allows everyone to waste as much money as they want on the Pokies, but it stops the spur-of-the-moment "I'll win big if I just keep going long enough" type of spending that problem gamblers get up to. In fact, what it does is allows problem gamblers to assert their "personal responsibility" before they stand in front of the hateful machines. More can be done, but this would be a big step in stopping these vampiric machines sucking the life out of their "customers". 

With the research suggesting that mandatory pre-commitment will actually work, the big beneficiaries from problem gambling have come out in force against it. Australian pubs, once providers of a social atmosphere and cheap meals, have now become simple Pokies Halls, deriving most of their profits from gambling. To be honest, they should admit that they are running on the broken lives of the problem gamblers, but obviously this is not a winning strategy to gain public support. Instead, pubs like the Grand North are littered with Party Political signs saying that it is “un-Australian” to help problem gamblers control their addiction. Personally, I’ll boycott any of these pubs just for using the term “un-Australian”. It suggests that there is some archetypical Aussie somewhere, probably in rural Queensland, that we can all measure ourselves up against to assess our Australianness, like John Howard wanting Bradman’s batting average to be on the Australian citizenship test. And if there is one group of people I don’t want defining “Australian” for me, it is the type of leech who lives off exploiting the pensioners I saw in the Grand North, with an oxygen tank strapped to their wheelchair and a dead look on their face as they fed the insatiable appetite of the Pokies.

Things that made me angry this week

In response to a request from David Cameron, Prime Minister of the United Kingdom, all of the constitutional monarchies in the Commonwealth agreed to change their law on succession. Under the current arrangements, when determining the inheritance of the British Crown, within each degree of relation, men take priority over women, and anyone married to a Catholic cannot accept the Crown. In the words of David Cameron, "The idea that a younger son should become monarch instead of an elder daughter simply because he is a man, or that a future monarch can marry someone of any faith except a Catholic - this way of thinking is at odds with the modern countries that we have become." Yes, it is quite archaic indeed. As is the basic idea that someone should be crowned ruler of a country and the head of the State Church simply because of an accident of birth. Good grief, if we are going to rationally discuss who inherits the Crown in three generations time, perhaps we could have a conversation on whether Britain, Australia, New Zealand, Canada, Jamaica, Antigua and Barbuda, Belize, Papua New Guinea, St Christopher and Nevis, St Vincent and the Grenadines, Tuvalu, Barbados, Grenada, Solomon Islands, St Lucia and the Bahamas should be endorsing the entire concept of royalty. 

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Qantas CEO Alan Joyce, the disgraceful weasel, blamed the Unions for shutting down air-traffic in Australia. Joyce has been ripping Qantas apart for years, outsourcing jobs and cutting real wages. The Unions involved have been trying to negotiate some job security and a wage rise, and what does Joyce do? Gave himself a 75% pay rise, to $5 million / year, and then shut down the entire airline rather than negotiate with the Unions. After the government stepped in to force a negotiation, the bastard blamed the Unions for industrial action, when it was not the Unions who went on strike but the management who locked out all the workers.

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The United States massively overreacted at Palestine applying for membership at the United Nations. 126 countries, representing 75% of the world's population, have recognised the State of Palestine. Palestine is now pushing for recognition by the United Nations, and is coming under severe criticism from the United States for doing so. The US is criticising Palestine for acting "unilaterally" and encourages it to take a more diplomatic route. Huh? Isn't asking the United Nations for diplomatic recognition the very definition of mulitlateral diplomacy? The UN (rightfully) recognises Israel, it should equally recognise Palestine, and the world should not have to wait until Palestinian recognition suits domestic Israeli politics. The other criticism from the US is that UN recognition would only be symbolic, in effect saying that there is not much gain to be made from it. Perhaps, but then why expend so much effort to destroy the effort? Now Palestine has been accepted as a member state by UNESCO, the agency which looks after World Heritage Sites. And the response from the US? To withdraw all American funding from UNESCO, slashing its budget by 20%. Israel in turn applauded the US and is considering its future within UNESCO. How is that a reasonable response? UNESCO simply allowed Palestine to join its mission "to contribute to the building of peace, the eradication of poverty, sustainable development and intercultural dialogue through education, the sciences, culture, communication and information". One would have thought that US and Israel would support such a mission being extended to Palestine, and UNESCO cannot be accused of being anti-semetic - they run holocaust education programs around the world, they protect holocaust memorial sites such as Auschwitz, and they actively support the preservation of sacred Jewish sites within Israel and around the world. How horrible for Palestine to want to be a part of that!

Despair of the asylum seeker

This story is a rare glimpse into the life of an asylum seeker living in Belgium. With much of the world war-torn and desolate, a rare few brave families risk the unknown in search of a better life, and a fraction of a fraction arrive in Belgium. Once in Belgium the families are safe from immediate persecution, and a few are granted refugee status, premitting them to stay indefinately and integrate into society. Far more, however are sans papiers - those waiting for judgement or those without what is considered adequate written proof of persecution but who come from a region unstable enough that they cannot be forced to leave. 

Legally, the Belgium government is to provide at least housing for asylum seekers, in practice the government has not built any where near enough places. Over and over again, homeless asylum seekers will take a case to the courts and judges will levy fines on the government for not meeting its legal obligations - and the government will just pay the fines rather than increase housing. Without "papers" the refugees cannot find a job and support themselves, they legally have no choice but to be sleeping on the street, begging and eating in soup kitchens. Even for those few who are granted papers life is no picnic, I remember waiting behind an Afghan man, probably in his late 40s, at the Leuven Town Hall, who was seeking permission to work. Over and over again he was denied permission, because his asylum papers said he was born 1/1/2000. He tried to explain that this was the default date because he didn't have a birth certificate (being born in a small Afghan village), they simply shut him down and said that they could not give a work permit to an 11 year old, and if he wanted to change it he would need to provide a valid birth certificate.

 To be sans papiers is to be left in limbo, to have no means to better yourself and no way to regain the dignity of self-sufficiency. It benefits nobody to leave people sitting unemployed in a cramped flat, sleeping out in an abandoned building intermittently raided by police, or freezing at night in an underpass. It certainly harms the most vulnerable members of our society. So who is to blame for this callus disregard for human dignity? Sure, you could blame the bureaucrats who make decisions, but they are only operating under the law. You could blame the politicians who make the laws, but with a thousand pressures on the political class the one issue they can safely ignore is the one which harms non-voters. You could blame the media, for ignoring the issue, but the media panders to populism and knows a dead issue when it sees one. No, ultimately we need to blame the voters, the people who could easily apply pressure for change, but who simply do not care enough about the plight of others to demand a minimum level of human dignity be granted to those who need it the most. 

Still, it could be worse. Mahboub and Rama and their two young children could have landed in Australia. They would have then been thrown straight into a prison (what other name can you call a "detention centre" set in the middle of the desert and surrounded by barbed wire?) and left to rot indefinately. Vilified by the Australian people as "boat people" and "que jumpers", asylum seekers have been condemned to life behind bars for up to seven years, before being deported or given papers. Australian governments of the right and left cite "processing requirements", but the real cause is clear - the racism of the Australian voter. While the idea of being stranded without rights on the streets of Brussels fills me with despair, living behind bars for the best part of a decade due to the "crime" of fleeing persecution is beyond my imagination.

Hummingbird smugglers?

In Australia we often call speedos "budgie smugglers", based on the *ahem* general similarity in size and shape of the enclosed package with that of a budgie (or parakeet, for Americans not familiar with Australian slang).

So what do you make of the smuggler who tried to smuggle humingbirds, the miniture relative of the humble budge, in his underwear?

The effect of the temperance movement on modern Australian drinking culture

Although far less famous than Prohibition in America, Australia had its own temperance movement which was successful in creating a partial prohibition for 50 years. After nearly 100 years of trying, conservative Christians in Australia finally managed a partial ban on alcohol in 1915 (see: Wowser;  an ineffably pious person who mistakes this world for a penitentiary and himself for a warder). Australia already had a long history of drug use and abuse, so it wasn't until the Christians managed to tie temperance to patriotism and war propaganda that they succeeded: "well-ordered, self-disciplined and morally upright home front was a precondition for the successful prosecution of the war."

The main success of the Australian temperance movement was a ban in bars serving alcohol after 6pm, which was in place across much of Australia from 1915-1967. The intent was to reduce drunkeness and enforce Christian "family values". The effect was the six o'clock swill, where men knocked off of work at 5 o'clock, rushed to a bar and then tried to drink as much as possible in the next hour. Between 5pm and 6pm, barmen stopped cleaning glasses and just walked around tables with a hose linked to the bar tap - spraying beer into empty glasses as fast as the men could drink them. They even redecorated the bars in response to the six o'clock swill, putting tiles on the walls and floors so they would be easy to clean afterwards. Then at 6pm the men staggered home drunk, to a surge of car crashes and domestic violence between 6:30 and 8pm.

Just as American prohibition left alcohol with the aura of sin and crime, so has Australian temperance left an impact on our relationship with alcohol. Not until living in Europe did I realise just how uniquely Australian the phenomenon of heading straight from work to a bar with colleagues for some heavy drinking was. 40 years after temperance was repealed, and we still drink in the style of our grandfathers.

An example of temperance propaganda in America

Alcohol laws have left another, darker, effect on Australia. Australian Aborigines were not recognised as full citizens across Australia until 1965 (Federal voting rights were granted in 1962, but Queensland held out until 1965 in State's rights). Even then, the Australian Constitution provided a unique racist loophole, which said that the States had the right to pass and enforce legislation that only affected the local Aboriginal population. This was the Constitutional basis of a whole raft of racist laws, which allowed the State to outlaw inter-racial socialisation and block the rights of Aboriginal Australians to free movement, free choice in marriage and parental rights. These racist laws were not invalidated until the 1967 referendum, which finally removed the States' powers to create race-specific laws.

Institutional racism has had enormous detrimental effects on the Aboriginal people, and unfortunately it has not stopped even today. But how does this relate to temperance? Well, one of the common racist laws imposed by the states was a prohibition on Australian Aborigines from drinking alcohol. Bans on voting and other major violations were severe but infrequent, the inability to walk into a bar and order a drink was a racist slight encountered each and every day. So, of course, when these laws were repealed drinking alcohol became a symbol of equality. While the extent of alcohol abuse among Australian Aborigines is often exaggerated, and the problem stems more from poverty and disempowerment, the historic effect of imposed prohibition lingers even today.

Tony Abbott discusses economic strategy

The legacy of war

From an Australian perspective, the wealth of modern Europe has been built up over centuries of development. Any tourist visit will only accentuate that impression, with grand buildings a thousand years old and art and technology dating back from before the "discovery" of Australia.

In one way, of course, this impression is absolutely true - regions like Flanders and northern Italy were economic powerhouses 600 years ago, and the slow accumulation of wealth over decades and centuries gives nations (and individuals) an unassailable advantage. This is why Black Americans have less wealth than white Americans after normalising for current income - even modern equality (if it were ever to exist) would not, by itself, wipe out the legacy of historical inequality.

In another way, however, this impression is quite misleading. Sure, you can walk around Brussels and see the 600 year-old city hall, and the Royal family has certainly built up its collection of palaces over the past 200 years. But these legacies of the past are the exception more than the rule. Modern Belgium has been built almost entirely over the past 60 years, on the rubble of the past. A very rich rubble, to be sure, but rubble nevertheless. Over 1% of the population of Belgium died in each of the two world wars (not unusual in western Europe, in central and eastern Europe figures over 10% are common), and the destruction of houses and infrastructure was much greater. Over 30,000 million tonnes of explosives fell upon Belgium during the wars, equivalent to more than a tonne of munitions per square metre of Belgian territory. Around a quarter did not explode, so even today ~200 tonnes of munitions are uncovered yearly by farmers and disposed of by the Belgian army.

This is the legacy of war, not only does it destroy what may have taken centuries to build, but it has the capacity to keep up the killing, long after the initiators have died. Even today Cambodia has 5 million unexploded landmines and hundreds of deaths every year. Anyone who advocates a war should first meet just a few of the 40 000 childhood amputees in Cambodia, who live today with the consequences of past decisions.

Random thoughts during sleep deprivation

In the only block of continuous sleep I have had in the last five days, I dreamt that I was a superhero with the power of running really fast, like the Flash. All was well until I got a phone call from the United Nations saying that they had reports coming out of a country-wide famine starting in Russia, and they needed my help to deal with it. I used my super speed to run really fast to UN headquarters. I then sat down at one of their computers and started trying to calculate the logistics of transporting massive amounts of food across a continent-spanning country. I woke up trying to solve the transportation bottleneck that was going to result from the reliance on a single east-west train track across Siberia. I guess even subconsciously my mind believes that real problems are much more difficult than those that could be fixed by super powers. Could have been inspired by reading this comic two weeks ago.

Minor culture shock during the birthing process. The Belgian nurses were shocked at me and Lydia not bringing underwear for Hayden. We just put a nappy on him and then dress or swaddle him. Four or five different nurses looked at us with near horror - "you don't wear underwear in Australia?". We, in turn, were shocked at the frequency with which the nurses insisted on sticking things up his bottom - eight times in the first 24 hours. We'd be finally sleeping at 1am and a nurse would walk in and have a thermometer up Hayden's rectum before he could cry "what the hell?". They frowned disapproval at our electronic thermometer that works in the ear.

Big thank you to the day-time nurses at Sint-Pieter. Always kind, gentle and helpful - just wonderful. Midwives tend to be an opinionated lot, with strong feelings about every topic, but they always phrased their advice as suggestions, saying that the choice was "up to us". Every test that had to be done they brought in the equipment and did it in the room at a time good for us (although to be honest, I wouldn't have minded if they said "we need to take him away for a few hours to run tests"). The night-time nurses, by contrast, were among the most disagreeable people I have ever had the misfortune to encounter, with only a few exceptions. We had one yell at Lydia for putting Hayden in a cot to sleep, rather than cosleeping. We had another tell us that "anytime your baby cries it means you are doing something wrong, babies don't cry for no reason". At 10pm, with Hayden soundly sleeping, a few half-whimpers brought in a nurse who insisted that he has gas and we need to keep on pocking a thermometer up his rectum until poo comes out. On the other hand, if my daily job was like the last five nights, then I would be a sour and bitter person too.

Average house size across three continents

Drug policy and civil liberties

‘The object of this Essay is to assert one very simple principle, as entitled to govern absolutely the dealings of society with the individual in the way of compulsion and control, whether the means used be physical force in the form of legal penalties, or the moral coercion of public opinion. That principle is, and the sole end for which mankind are warranted, individually or collectively, in interfering with the liberty of action of any of their number, is self-protection. That the only purpose for which power can be rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant.

            - John Stuart Mill, On Liberty, 1869

Civil liberties are often portrayed in the media as a costly conceit, in which the right to privacy overrides considerations of safety and social order. In the context of drug policy, accepting infringements on civil liberties is usually considered essential for the government’s ability to protect the public from the effects of illicit drugs. Far too rarely is the assumption challenged that loss of civil liberties must result in gains elsewhere. Punitive prohibition drug control policies, as the most extreme drug policy example of civil liberties sacrifices, do not show any indisputable social, health or economic advantage above harm reduction policies which respect civil liberties, often making the choice between civil liberties and social order a false dilemma. Despite this, civil liberties and public health can come into conflict in situations where policy options are available which increase public health at the expense of individual rights. 

The philosophy of civil liberties

Civil liberties include the right to privacy, the freedom of speech, freedom of and from religion, and the right to the due process of law. The legal context of individual civil liberties has been developing since antiquity, with legal documents such as the Magna Carta and the United States (US) Bill of Rights being pivotal in the declaration of individual rights which cannot be restricted by others. The philosophical basis of civil liberties has been developed by enlightenment philosophers and underpins modern liberal humanism. In the argument developed by Kant and Mills, civil liberty is essentially the right of autonomy, whereby the individual has an inalienable right to self-determination in all aspects of their life which do not conflict with the autonomy of other individuals. In this philosophical context, the government is free to encourage particular behaviours in individuals, but may only resort to coercion in order to prevent one individual from harming another. As the right of an individual to use drugs to manage pain is considered a fundamental human right, can the medicinal use of marijuana be ethically prohibited? Furthermore, positive effects of drug use are not necessary for individuals to have the right to choose substance use, as the essence of autonomy is to allow individual choice and prohibition violates this autonomy.

Civil liberties and punitive prohibition

A large number of drugs are subject to international prohibitions on production, trafficking, sales, purchase and use, subject to punitive measures. This act of making drugs illicit is a limitation on individual autonomy in decision making, and can therefore be argued as being a civil liberties violation. However under the ethical framework of Mills, coercive intervention is permissible in order to prevent others from harm arising from the individuals use. For punitive prohibition the intention of the coercive intervention is not the protection of the individual from self-harm, as the harm inflicted upon the individual in response to their drug-use (e.g. incarceration) is often greater than the harm that came directly from that use. Rather, the intention of punitive prohibition is to use individual punishment for the benefit of others, on the grounds that the act of drug-taking causes harm to others by encouraging the social conditions in which others may make the same choice. While rarely articulated in this manner, the justification of punitive prohibition is essentially based on this conflict between allowing an individual right to exercise their autonomy when the choices of that individual have negative impacts upon society. In order for this conflict to become a true struggle between individual civil liberties and societal freedoms, the outcome of punitive prohibition must cause less total harm than the prohibited substance.

Firstly, what are the limitations placed upon the autonomy of those individuals who still participate in the drug trade through illegal markets? The strongest example of punitive prohibition is the US, which has operated a “War on Drugs” lasting nearly 40 years and currently spending over US$40 billion per year. The key policy focuses have been to eliminate drug trafficking and to increase the personal costs of using illegal drugs. The most direct increased personal cost in using drugs is incarceration. Currently in the US 1 in 32 adults is in prison, a total of 2 million (or ~25%) of the world’s 9 million prisoners, half of which are incarcerated due to drug offences.

The increased cost to the drug users is not only experienced through incarceration. Many of the official policies in the US (and to a lesser extent in Australia through the Howard “Tough on Drugs” policy) increase the costs of drug use far beyond direct legal ramifications and exposes them to discrimination which increases the vulnerability of the drug user to elevated harm. A recent survey of US drug treatment program attendees found that 47% had experienced civil liberties violations, such as one third being the victim of police harassment and illegal police tactics (including unlawful search and denial of access to an attorney) and 14% being denied a job due to their criminal record. Other studies showed that police harassment reduces the uptake of harm reduction programs in drug users. Only 18% of those who experienced civil liberties violations sought legal help for these issues, largely because they did not know the actions were illegal. Other forms of discrimination in the US are legal under the Personal Responsibility and Work Opportunity Reconciliation Act, the Fair Housing Act and the Americans with Disabilities Act. These prohibit persons with drug conviction from receiving student loans and grants, temporary assistance, and food stamps. Drug use is grounds for expulsion from public housing and disability due to drug use is grounds for exclusion from supplemental security income. While punitive measures against drug users who cause harm to others is reasonable, the over-criminalisation of drug use results in an inordinate amount of harm to users. Punishing drug users for exercising their autonomy is a civil liberties violation, and does not result in a net harm reduction to the individual.

What are the societal benefits that are achieved through the sacrifice of civil liberties of the users? Despite the overwhelming legislative and social discrimination of drug users, trade in illicit drugs constitutes 8% of all international trade. Even the US, with the highest level of anti-trafficking spending, does not exhibit levels of drug use any lower than countries which have non-punitive forms of drug policy, such as the Netherlands. As well as the personal harm caused to drug users, they show a high rate of adopting additional criminal behaviour after incarceration, increasing the indirect costs to society. Furthermore, the illegal nature of the drug trade is the cause of the majority of the violence and deaths associated with drugs, through the organisation of crime syndicates. Thus the return from the violation of civil liberties caused by punitive prohibition policies is an increase in harm to the user, a decrease in public health, and an increase in the societal harm caused by indirect costs to non-users. Thus, rather than representing a difficult choice in balancing civil liberties and societal good, punitive prohibition policies represent examples of simultaneous reductions in both individual civil liberties and societal freedoms.

Civil liberties and harm minimisation intervention

Despite the societal and public health disadvantages of punitive prohibition, governments are ethically obligated to minimalise harm from drug use. An alternative to punitive prohibition is to provide services and conditions in a non-coercive manner, in order to persuade individuals to exercise their autonomy in a less harmful manner. This public health framework shows a much greater success in reducing harm due to drug use than the criminal framework of punitive prohibition. As an advantage, it is not a violation of civil liberties to provide education and positive (non-coercive) incentive for individuals to make their behaviour less harmful.

There are two threads to harm minimisation. Firstly, encouraging reduced drug use through non-punitive measures such as fiscal constraint, counselling and education, and secondly, reducing the harm that occurs due to drug use. Tobacco is an example of a drug that is being controlled through harm minimisation. Fiscal constraint is an efficient method of reducing tobacco use, for every rise in the price of cigarettes by 10%, adult demand is reduced by 4% and child demand is reduced by 6%. When advertising of tobacco products was restricted, demand was reduced by 7%. Active anti-tobacco education campaigns are also effective, for example the National Tobacco Campaign program “every cigarette is causing you damage” provided encouragement to quit to 48% of smokers. Only 7% of smokers succeed in quitting by themselves, however even brief advice from doctors or counsellors can increase this rate. An example of harm reduction is the introduction of filters and low tar cigarettes, to reduce the damage (incidence of lung cancer) caused by drug taking.

Even with currently illicit drugs there are strong rewards for using a harm minimisation approach. An analysis by the US Army showed that the return of drug policy spending on treatment programs ($7.48 per dollar spent) was greater than the return of spending on coca eradication (32c), tackling trafficking (32c) or enforcing customs (52c). The Netherlands uses a non-punitive prohibition policy for marijuana to normalise the position of drug users in society, and has lower levels of drug-related crime and deaths than the US. Needle and syringe programs have an outstanding record of reducing harm due to infectious disease in intravenous drug users, with the Australian government response restraining HIV infection to 3% compared to 14% in the US without increasing drug use or crime. Likewise Operation Ceasefire in Boston demonstrate decoupled gang violence from the drug trade, with a successful 63% reduction in youth homicides. These examples demonstrate that harm minimisation policies respectful of civil liberties can in fact be far more successful than punitive prohibition in protecting social and public health.

Civil liberties and drug testing

The most common battleground between civil liberties and drug policy is in the realm of drug-testing. The most prevalent example of this is random breath testing (RBT) of drivers for alcohol levels above the legal limit. This is clearly an infringement of civil liberties, a police search without due cause. Despite this, there is wide-spread support for RBTs in Australia. The link between blood alcohol and traffic accidents is well appreciated, and the results since the introduction of RBTs has been clear – introduction caused an average 22% decrease in traffic fatalities, and for every additional 1000 tests/day introduced there is a 6% decline in serious accidents.

The other common example of drug-testing is workplace testing for drug use in employees. This became prevalent in the US in the 1980s and 90s, through Employment Assistance Programs (EAPs), and is becoming more common in Australia. In 2000 60% of US worksites provided EAPs to 62 million American workers. Support for drug-testing is high among employers, due to issues like duty of reasonable care, company performance and company image. Despite this, drug-testing is unpopular with workers, as even in the US only 38% of those surveyed believed workplace drug-testing was a necessity. In both the US and Australia, employers are no longer considered entitled to know personal details about employees such as marital status, sexuality, political orientation or religion. Drug-testing can be a similar invasion of privacy, both in technique (especially monitored urination) and in results (past drug use, pregnancy, infections, diabetes, prescribed treatments and various diseases can all be measured from the sample). Urine, blood and saliva tests detect drugs up to four days prior (and up to a month in the case of cannabis), while hair tests can measure drug use within the past three months, therefore unlike the RBT drug-testing these tests measure past drug-use rather than current incapacity.

Yet employees have an obligation to provide a safe working environment, such as in preventing passive smoking. Employers argue that since raised blood alcohol may have contributed to 5.3% of Australian workplace deaths, Occupational Health and Safety liability requires drug-testing. By contrast, the ACTU stance is that the employer has a right to test for performance impairment, but not for drug and alcohol use, since focussing on drug use creates industrial tension, ignores unsafe workplace conditions and does not detect non-drug impairment due to causes such as fatigue. In industrial disputes over drug-testing in high-risk occupations, the ACTU has offered to accept stress and impairment tests in place of drug-testing. In a similar manner NASA uses computer-based performance tests that measure hand-eye coordination and response times for astronauts and test pilots, as these tests measure additionally measure stress and fatigue and give greater safety improvements.

In low-risk occupations there is less cause for workplace drug-testing based on safety and no clear data drug-testing increases company performance. Most workers who use illicit drugs never use them at work and don’t use them in a way that affects performance. The net performance effects are therefore negative (a 29% decrease in productivity), with increased employee turnover and anxiety due to the atmosphere of distrust and the potential for coercive use.

Drug-testing is widely accepted where the test measures current incapacity in individuals undergoing a high-risk activity (e.g. driving, high-risk workplaces), despite the conflict with civil liberties. Where drug-tests are not available to measure current incapacity, performance tests give greater safety improvements than drug-tests without civil liberties concerns. Drug testing in low-risk workplaces are generally based more on profit and image than on safety, and are counter-productive, with the atmosphere of distrust generated countering any improvements from reduced drug use.

Civil liberties and public health in conflict

In the examples above there is little conflict between civil liberties and public health. Those policies which violate civil liberties, such as punitive prohibition and drug-testing, generally have little public health benefit, while those policies which respect civil liberties, such as harm reduction and performance testing, show large public health benefits. However the example of RBTs demonstrated that this segregation is not always exact, and there are cases where a policy constitutes a clear violation of civil liberties yet equally has a public health benefit. An ethical limitation on government is that coercive intervention should be limited to the minimum required to achieve the goal, so in cases where a public benefit could be achieved with or without a loss of civil liberties, it is incumbent upon the government to use the method which does not violate civil liberties. However, in some cases the most effective policy appears to be in conflict with civil liberties.

The case for prohibition of drug use by children is complex with regards to civil liberties. On the one hand, children have rights of autonomy as individuals. On the other hand, it can be argued that only when an individual is informed can they truly make autonomous decisions. If children take drugs without full comprehension of their impact (such as the risk of addiction or long-term medical consequences) that action can deny them the ability to act autonomously as an adult. For drugs where there is clear evidence that use impairs later facility to make autonomous choice, childhood prohibition can be considered within the civil liberties framework. However, the imposition of harm due to this prohibition can negate this justification, such as when punitive measures cause greater harm to the child than substance use would.

Other examples also exist where a policy can have clear public health benefits while simultaneously reducing civil liberties. Tobacco use, for example, has been steadily declining in Australia since the 1970s. While the policy framework is largely based on harm minimisation, there are aspects of prohibition involved, such as banning sale in small packets (which is demonstrated to reduce the availability to children), and the banning of smoking in workplaces and public places (to reduce harm due to passive smoking). Here the autonomous right to use tobacco has been restricted, and yet public health improvements have occurred.

While wide-scale alcohol prohibition was a public health failure when attempted in the US, this does not mean that alcohol prohibition cannot be feasible under certain circumstances. For example, the Mayor of Eindhoven in the Netherlands enforced a temporary partial ban on alcohol, restricting the sale of beer to half-strength beer during the Euro2000 football match. They found comparatively less violence than other cities hosting matches. When such policies exist, should a higher value be placed on maintaining autonomy of the individual or on the achievement of the greatest reduction in harm? This question becomes especially complex when the individual who is subjected to the loss of autonomy is not a recipient of the reduction of harm to the wider community.

Resolving the conflict

In my opinion, the emphasis of the individual in civil liberties is paramount. It is through the confirmation of the absolute inalienability of autonomy that true social cohesion is achieved, as individuals become invested in the social structure that guarantees their rights. When social order is achieved by restrictions on autonomy, the best interests of the individual may conflict with the best interests of the society, thus creating tension against the imposed social order (such as in the negative social impacts of punitive prohibitive policies, or in the productivity loss due to drug-testing in low-risk occupations). Conflict does occur, however, when violations of individual autonomy have social benefits, such as in the example of RBT of drivers for alcohol, or by mandated attendance to Alcoholics Anonymous for repeat drink drivers. Here it is necessary to weigh the burden imposed on the individual with the benefit they will receive as an individual within the society.

It is unfair to simply ask if the majority of individuals would be willing to have that burden placed upon others for the benefit of all. Such situations can result in extremely onerous burdens being placed upon a minority of individuals, such that the majority receive a mild net benefit but a minority receive a severe net harm. Yet to make measures completely voluntary will negate their impact. Rather, the criterion for suppression of civil liberties should be whether the majority of individuals would be willing to accept for themselves the burden in the form that will be placed upon those who will bear the brunt of it in return for the net gain they will receive through societal benefits. In the example of RBT, the majority of people agree that the violation of their personal privacy without due cause is acceptable because of the reduction in harm that society gains from the practise. Even if people were asked if they would accept the greatest burden that will be experienced, such as being held up in traffic despite their innocence, they may consider it a reasonable burden as long as the violation of privacy is restricted to information about blood alcohol content and measures are made to reduce lost time during the screening. In the example of mandated attendance to Alcoholics Anonymous, while the majority may accept repeat drink drivers being forced into counselling, the majority may not accept that burden themselves if they were exposed to it in the most onerous form. If people were asked if they would accept being forced into a program which required the profession of belief in a religion to which they did not adhere, they may not consider it reasonable.

Concluding remarks

Despite the perceived conflict between civil liberties and societal gain, the most effective drug policies are generally those that respect autonomy. Yet examples do exist where the most effective policy includes a reduction of civil liberties. In these cases, by considering the degree of civil liberties violation imposed upon the individuals with the greatest burden the minimum amount of conflict is created between the individual and the society. No individual is asked to sacrifice any more autonomy than the majority would be willing to personally give up in order to receive the societal benefits. This principle creates a fluid situation, as the individual burden and societal benefits vary with policy detail and social context, such that mandated counselling attendance for repeat drink drivers may be considered reasonable if it was more effective and did not include a religious component, and RBT for alcohol could be considered unreasonable if technology changes eliminated the risk of harm due to driving under the influence. While this approach does not maximise the public health benefits, it does, in my opinion, strike the right balance between individual and societal rights by maximising social justice.