According to the “internal” conception (Quong), political liberalism aims to be publicly justifiable only to people who are reasonable in a special sense specified and advocated by political liberalism itself. One advantage of the internal conception allegedly is that it enables liberalism to avoid perfectionism. The paper takes issue with this view. It argues that once the internal conception is duly pitched at its fundamental, metatheoretical level and placed in its proper discursive context, it emerges that it comes at the (...) cost of publicdogma. The paper examines this problem and argues that a plausible response to this problem is to go beyond the internal conception and adopt a more inclusive, dynamic conception. But this calls for a form of perfectionism. Thus, the internal conception of political liberalism, far from showing how liberalism can be had without perfectionism, effectively calls for perfectionism as a remedy for its problems. (shrink)
It has become increasingly difficult to distinguish public health from related fields like social work. I argue that we should reclaim the more traditional conception of public health as the provision of health-related public goods. The public goods account has the advantage of establishing a relatively clear and distinctive mission for public health. It also allows a consensus of people with different comprehensive moral and political commitments to endorse public health measures, even if they (...) disagree about precisely why they are desirable. (shrink)
It is often claimed that there is an obesity epidemic in affluent countries, and that obesity is one of the most serious public health threats in the developed world. I will argue that obesity is not an 'epidemic' in any useful sense of the word, and that classifying it as a public health problem requires us to make fairly controversial moral and empirical assumptions. While epidemiological evidence suggests that the prevalence of obesity is on the rise, and that (...) obesity can lead to serious health problems ranging from diabetes to cardiovascular disease, this does not by itself show that obesity is a public health problem. (shrink)
Multiculturalism requires sustained and serious philosophical reflection, which in turn requires public outreach and communication. This piece briefly outlines concerns raised by the philosophy of multiculturalism and, conversely, multiculturalism in philosophy, which ultimately force us to reconsider the philosopher’s own role and responsibility. I conclude with a provocative suggestion of philosophy as /public diplomacy/. (As this is intended to be a piece for a general audience, secondary literature is only referred to in the conclusion. References gladly provided upon (...) request.). (shrink)
....a notion of 'common, public language' that remains mysterious...useless for any form of theoretical explanation....There is simply no way of making sense of this prong of the externalist theory of meaning and language, as far as I can see, or of any of the work in theory of meaning and philosophy of language that relies on such notions, a statement that is intended to cut rather a large swath. (Chomsky 1995, pp. 48-9) It is a striking fact that despite (...) the constant reliance on some notion of 'community language' or 'abstract language,' there is virtually no attempt to explain what it might be. (Chomsky 1993, p. 39) ....either we must deprive the notion communication of all significance, or else we must reject the view that the purpose of language is communication. ...It is difficult to say what 'the purpose' of language is, except, perhaps, the expression of thought, a rather empty formulation. The functions of language are various. (Chomsky 1980, p. 230) I have yet to see a formulation that makes any sense of the position that "the essence of language is communication." (Chomsky 1980, p. 80; see also 1992b, p 215). (shrink)
This paper introduces the concept of collective intentionality and shows its relevance when we seek to understand public management. Social ontology – particularly its leading concept, collective intentionality – provides critical insights into public organisations. The paper sets out the some of the epistemological limitations of cultural theories and takes as its example of these the group-grid theory of Douglas and Hood. It then draws upon Brentano, Husserl and Searle to show the ontological character of public management. (...) Modern public institutions – such as advisory organisations and service delivery agencies, including schools and universities – are expressions of human collective intentionality. The central concept within these institutions, as a phenomenology reveals, is cooperation. Public institutions are natural structures that emerge from our evolutionary ancestry as cooperative animals and enduringly display all the features of that ancestry. (shrink)
In this article, I seek to make sense of the oft-invoked idea of 'public emergency' and of some of its (supposedly) radical moral implications. I challenge controversial claims by Tom Sorell, Michael Walzer, and Giorgio Agamben, and argue for a more discriminating understanding of the category and its moral force.
In this paper, I assess Martha Nussbaum's application of the capabilities approach to non-human animals for both its philosophical merits and its potential to affect public policy. I argue that there are currently three main philosophical problems with the theory that need further attention. After discussing these problems, I show how focusing on factory farming would enable Nussbaum to demonstrate the philosophical merits of the capabilities approach as well as to suggest more powerful and effectives changes in our (...) class='Hi'>public policies. (shrink)
No natural rights theory justifies strong intellectual property rights. More specifically, no theory within the entire domain of natural rights thinking – encompassing classical liberalism, libertarianism and left-libertarianism, in all their innumerable variants – coherently supports strengthening current intellectual property rights. Despite their many important differences, all these natural rights theories endorse some set of members of a common family of basic ethical precepts. These commitments include non-interference, fairness, non-worsening, consistency, universalisability, prior consent, self-ownership, self-governance, and the establishment of zones (...) of autonomy. Such commitments have clear applications pertaining to the use and ownership of created ideas. I argue that each of these commitments require intellectual property rights to be substantially limited in scope, strength and duration. In this way the core mechanisms of natural rights thinking ensure a robust public domain and categorically rule out strong intellectual property rights. (shrink)
This collection of new essays derives from a conference sponsored by the Royal Institute of Philosophy and the Centre of Philosophy and Public Affairs at the University of St Andrews. It brings together a number of prominent academics from the fields of philosophy and political theory along with politicians and social commentators. The subjects covered include liberalism, education, welfare policy, religion, art and culture, and cloning. The mix of contributors and the topicality of the subject matter should further promote (...) a serious engagement between philosophy and public life. (shrink)
Preface -- Part I : Mastering the basics. The importance of public relations : Case: UPS faces losses in Teamster's union strike ; What is public relations? ; Models and approaches to public relations ; Public relations as a management function -- Part II : Organizations and processes. Organizational factors contributing to excellent public relations ; How public relations contributes to organizational effectiveness ; Identifying and prioritizing stakeholders and publics ; Public relations research: (...) the key to strategy ; The public relations process: RACE -- Part III : The practice and best practices. The practice of public relations ; Ethics, leadership and counseling roles, and moral analyses ; Best practices for excellence in public relations -- Notes -- References -- Index. (shrink)
Listening closely to the religious pitch in Rousseau's voice, Cladis convincingly shows that Rousseau, when attempting to portray the most characteristic aspects of the public and private, reached for a religious vocabulary. Honoring both love of self and love of that which is larger than the self--these twin poles, with all the tension between them--mark Rousseau's work, vision and challenge--the challenge of 21st-century democracy.
A social scientific survey on visions of human/nature relationships in western Europe shows that the public clearly distinguishes not only between anthropocentrism and ecocentrism, but also between two nonanthropocentric types of thought, which may be called “partnership with nature” and “participation in nature.” In addition, the respondents distinguish a form of human/nature relationship that is allied to traditional stewardship but has a more ecocentric content, labeled here as “guardianship of nature.” Further analysis shows that the general public does (...) not subscribe to an ethic of “mastery over nature.” Instead, practically all respondents embrace the image of guardianship, while the more radical relationships of partnership and participation also received significant levels of adherence. The results imply that ethicists should no longer assume that the ethics of the public are merely anthropocentric. Finally, they call into question the idea of a single form of ecocentrism and favor a hermeneutic virtue ethics approach to the study of the interface between ethics and action. (shrink)
This paper is about how best to understand the notion of ‘public wrongs’ in the longstanding idea that crimes are public wrongs. By contrasting criminal law with the civil laws of torts and contracts, it argues that ‘public wrongs’ should not be understood merely as wrongs that properly concern the public, but more specifically as those which the state, as the public, ought to punish. It then briefly considers the implications that this has on criminalization.
Public justification-based accounts of liberal legitimacy rely on the idea that a polity’s basic structure should, in some sense, be acceptable to its citizens. In this paper I discuss the prospects of that approach through the lens of Gerald Gaus’ critique of John Rawls’ paradigmatic account of democratic public justification. I argue that Gaus does succeed in pointing out some significant problems for Rawls’ political liberalism; yet his alternative, justificatory liberalism, is not voluntaristic enough to satisfy the desiderata (...) of a genuinely democratic theory of public justification. Moreover I contend that — pace Gaus — rather than simply amending political liberalism, the claims of justificatory liberalism cast serious doubts on the sustainability of the project of grounding liberal-democratic legitimacy through the idea of public justification. (shrink)
The individual management of online identity, as part of a wider politics of personal information, privacy, and dataveillance, is an area where public policy is developing and where the public sector attempts to intervene. This paper attempts to understand the strategies and methods through which the UK government and public sector is engaging in online identity management. The analysis is framed by the analytics of government (Dean 2010) and governmentality (Miller and Rose 2008). This approach draws attention (...) to the wide assemblage of public and private actors with shared regimes of practice and fields of visibility, as well as to the extent to which individual actors are made responsible for their own identity management. The paper also uses communication and discursive research to examine the potential failings of engagement efforts. Communication theory suggested that the assumption of individual responsibility, alongside linguistic distortions created by this way of understanding the problematic of identity management, complicate and fundamentally limit engagement activity. (shrink)
Healthcare counts as a morally relevant good whose distribution should neither be left to the free market nor be simply imposed by governmental decisions without further justification. This problem is particularly prevalent in the current boom of anti-ageing medicine. While the public demand for medical interventions which promise a longer, healthier and more active and attractive life has been increasing, public healthcare systems usually do not cover these products and services, thus leaving their allocation to the mechanisms of (...) supply and demand on the free market. This situation raises the question on which basis the underlying preferences for and claims to a longer, healthier life should be evaluated. What makes anti-ageing medicine eligible for public funding? In this article, we discuss the role of anti-ageing medicine with regard to the scope and limits of public healthcare. We will first briefly sketch the basic problem of justifying a particular healthcare scheme within the framework of a modern liberal democracy, focusing on the challenge anti-ageing interventions pose in this regard. In the next section, we will present and discuss three possible solutions to the problem, essentialistic, transcendental, and procedural strategies of defining the scope of public healthcare. We will suggest a procedural solution adopting essentialistic and transcendental elements and discuss its theoretical and practical implications with regard to anti-ageing medicine. (shrink)
This collection of essays by Sheila Jasanoff explores how democratic governments construct public reason, that is, the forms of evidence and argument used in making state decisions accountable to citizens.
The article deals with the role of public addresses delivered by the US first lady Michelle Obama in forming the presidential image. Special attention is paid to communicative strategies, stylistic and lexico-grammatical means used in public addresses for influencing the electorate. It is shown that both Obama and his spouse’s speeches play an important role in the electorate consciousness manipulation in the USA.
This paper examines whether religious reasons have a legitimate place in a liberal democracy's policy debates. Robert Audi, building from Rawlsian themes, contends that civic virtue obliges religious citizens who advocate for public policies to have sufficiently motivating secular reasons. Others contend it's unfair to exclude reasonable citizens from policy debates merely because their only reasons are religious ones. This essay seeks to reconcile the intuitions behind these competing views. I examine Audi's account of the differences between religious and (...) secular reasons to determine why he believes religious reasons are inappropriate to justify coercive policies. Of the distinctions he discusses, only one -- religious reasons are often grounded in an infallible authority -- is relevant for distinguishing suitable from unsuitable policy justifications. I develop an alternative to Audi's account: Individuals should refrain from bringing reasons held to be infallibly true to policy debates. On this view, not all religious reasons will warrant exclusion, though some may. (shrink)
While public administration research is thriving because of increased attention to social scientific rigor, lingering problems of methods and ethics remain. This article investigates the reporting of ethics approval within public administration publications. Beginning with an overview of ethics requirements regarding research with human participants, I turn to an examination of human participants protections for public administration research. Next, I present the findings of my analysis of articles published in the top five public administration journals over (...) the period from 2000 to 2012, noting the incidences of ethics approval reporting as well as funding reporting. In explicating the importance of ethics reporting for public administration research, as it relates to replication, reputation, and vulnerable populations, I conclude with recommendations for increasing ethics approval reporting in public administration research. (shrink)
New settings for communication are being built, having, at one side, great corporations of television, radio, press and on line media, and at the other side the role of the independent / alternative press, understood as not bound to a private, public or state enterprise or to some economic group. It takes gradually shape the constitution of the opposition between the traditional media and the independent / alternative press, having as a material base the new technologies of information. How (...) can the new technology of information associated to the new settings of press freedom and the phenomenon of the contradiction of public opinion in the era of internet accomplish the mediation of the opinion in a globalized society? Or still, starting from the presupposition of the press freedom, how to guarantee that the society solves the contradiction of the public opinion? The phenomenon of the public opinion is contradicting because it has in itself, at the same time, the universality of constitutional principles of Law and Ethics, together with the peculiarity of the citizens’ rights and concerns. This contradiction finds its solution by means of the mediation of the freedom of the press itself within a frame of democratic legality. This is the power of the contradiction: to put into effect the dialectic tension between the opposed poles of the universal and the particular in the press freedom, avowing the right of every citizen to express publicly his opinion. This is Hegel’s theory of public opinion: the press freedom and the parliament, as a politic space, are privileged spheres of the mediation of the contradictory phenomenon of the public opinion. Keywords: Press freedom; public opinion; press; citizen journalists. (shrink)
This paper tackles with the issue of the place of comprehensive beliefs within the public space. It tries to strike a middle path between the liberal ban on comprehensive beliefs and the anti-liberal claim that comprehensive beliefs should be given full pride of place in public deliberations. The article relies on arguments that are inspired by the pragmatist tradition. It starts locating the main cause of failures at articulating comprehensive beliefs and public reason in a central feature (...) of liberal epistemology, namely the way it conceives public reason via a preliminary distinction between public and non public beliefs. After criticizing this distinction, the article introduces a distinction between the normative practice of justification and the normative practice of adjudication as a more perspicuous way to establish the place that comprehensive beliefs should play within political forums. It then concludes showing that this approach provides a satisfying answer to the issue of the public role of comprehensive beliefs in a liberal democratic regime that is respectful of citizens’ thick identities while at the same time complying with the requirements of respect set by the liberal tradition. Keywords: public reason and religion - pragmatism - liberalism - communitarianism - normative practices. (shrink)
This paper presents a novel view of the concept of cognitive enhancement by taking a population health perspective. We propose four main modifiable healthy lifestyle factors for optimal cognitive functioning across the population for which there is evidence of safety and efficacy. These include i) promoting adequate sleep, ii) increasing physical activity, iii) encouraging a healthy diet, including minimising consumption of stimulants, alcohol and other drugs including nicotine, iv) and promoting good mental health. We argue that it is not ethical (...) to promote or sanction the use of pharmaceutical drugs as putative cognitive enhancers without acknowledging the adverse effects on population cognitive health of failing to encourage the pursuit of healthy behaviours. We conclude with recommendations to increase the public health relevance of bioethical analyses of the cognitive enhancement debate. (shrink)
Following Hugo Grotius, a distinction is developed between private and public war. It is argued that, contrary to how most contemporary critics of the moral equality of combatants construe it, the just war tradition has defended the possibility of the moral equality of combatants as an entailment of the justifiability of public war. It is shown that contemporary critics of the moral equality of combatants are denying the possibility of public war and, in most cases, offering a (...) conception of just war as exclusively private war. The work of Jeff McMahan is used to exemplify this. Against these contemporary critics, it is argued that the reasons McMahan and others offer against the possibility of the moral equality of combatants undermine not only public war but also the possibility of fully realized and effective political authority. (shrink)
Obesity has been described as pandemic and a public health crisis. It has been argued that concerted research efforts are needed to enhance our understanding and develop effective interventions for the complex and multiple dimensions of the health challenges posed by obesity. This would provide a secure evidence base in order to justify clinical interventions and public policy. This paper critically examines these claims through the examination of models of public health and public health ethics. I (...) argue that the concept of an effective public health intervention is unclear and underdeveloped and, as a consequence, normative frameworks reliant on meeting the effectiveness criterion may miss morally salient dimensions of the problems. I conclude by arguing for the need to consider both an ecological model of public health and inclusion of a critical public health ethics perspective for an adequate account of the public health challenges posed by obesity. (shrink)
Targeting high-risk populations for public health interventions is a classic tool of public health promotion programs. This practice becomes thornier when racial groups are identified as the at-risk populations. I present the particular ethical and epistemic challenges that arise when there are low-risk subpopulations within racial groups that have been identified as high-risk for a particular health concern. I focus on two examples. The black immigrant population does not have the same hypertension risk as US-born African Americans. Similarly, (...) Finnish descendants have a far lower rate of cystic fibrosis than other Caucasians. In both cases the exceptional nature of these subpopulations has been largely ignored by the designers of important public health efforts, including the recent US government dietary recommendations. I argue that amending the publicly-disseminated risk information to acknowledge these exceptions would be desirable for several reasons. First, recognizing low-risk subpopulations would allow more efficient use of limited resources. Communicating this valuable information to the subpopulations would also promote truth-telling. Finally, presenting a more nuanced empirically-supported representation of which groups are at known risk of diseases (not focusing on mere racial categories) would combat harmful biological race essentialist views held by the public. (shrink)
Media in Question sets the agenda for a revitalized debate on the hybrid communicative practices that constitute the postmodern media landscape: practices that cross the boundaries between fact and fiction, information and entertainment, public knowledge, and popular culture. In this challenging and provocative collection, the individual contributors rethink key issuesùthe meaning of the public interest, the quality of media performance, and deregulation. In the process they raise questions rarely addressed in normative media theories, for example, the ethics of (...) sports reporting, the moral reasoning in popular culture, and the required professional standards for infotainment genres such as reality television and gossip journalism. Accessible and wide-ranging, The Media in Question will be essential reading for students in mass communication and political communication studies. (shrink)
The study of threat and fear appeal arguments has given rise to a sizeable literature. Even within a public health context, much is now known about how these arguments work to gain the public’s compliance with health recommendations. Notwithstanding this level of interest in, and examination of, these arguments, there is one aspect of these arguments that still remains unexplored. That aspect concerns the heuristic function of these arguments within our thinking about public health problems. Specifically, it (...) is argued that threat and fear appeal arguments serve as valuable shortcuts in our reasoning, particularly when that reasoning is subject to biases that are likely to diminish the effectiveness of public health messages. To this extent, they are rationally warranted argument forms rather than fallacies, as has been their dominant characterization in logic. (shrink)
This latest volume in the Oxford Readings in Feminism series presents the results of the multi-disciplinary feminist exploration of the distinction between public and private. Contributors demonstrate the significance of the distinction in feminist theory, its articulation in the modern and late modern public sphere, and its impact on identity politics within feminism in recent years. Feminism, the Public and the Private offers an essential perspective on feminist theory for students and teachers of women's and gender studies, (...) cultural studies, history, political theory, geography and sociology. (shrink)
Developments in the field of neuroscience, according to its proponents, offer the prospect of an enhanced understanding and treatment of addicted persons. Consequently, its advocates consider that improving public understanding of addiction neuroscience is a desirable aim. Those critical of neuroscientific approaches, however, charge that it is a totalising, reductive perspective–one that ignores other known causes in favour of neurobiological explanations. Sociologist Nikolas Rose has argued that neuroscience, and its associated technologies, are coming to dominate cultural models to the (...) extent that 'we' increasingly understand ourselves as 'neurochemical selves'. Drawing on 55 qualitative interviews conducted with members of the Australian public residing in the Greater Brisbane area, we challenge both the 'expectational discourses' of neuroscientists and the criticisms of its detractors. Members of the public accepted multiple perspectives on the causes of addiction, including some elements of neurobiological explanations. Their discussions of addiction drew upon a broad range of philosophical, sociological, anthropological, psychological and neurobiological vocabularies, suggesting that they synthesised newer technical understandings, such as that offered by neuroscience, with older ones. Holding conceptual models that acknowledge the complexity of addiction aetiology into which new information is incorporated suggests that the impact of neuroscientific discourse in directing the public's beliefs about addiction is likely to be more limited than proponents or opponents of neuroscience expect. (shrink)
This collection provides a fresh and wide-ranging assessment on the changing nature of the public-private debate. For the first time, eight essays by scholars provide insight into this issue from a number of disciplinary perspectives. The focus of recent debates on this topic has been the delineation of acceptable boundaries between the public and the private in the economic, social and cultural spheres of modern societies. Tough questions are raised pertaining to the nature and scope of citizenship, privacy (...) rights, the implications of new reproductive technologies, and the fate of state sovereignty in the context of a globalized world economy. All of these issues discussed in this book bring serious concerns about the distinction between public and private to light. (shrink)
In this paper, the public view of nanotechnology and its applications in medicine, agriculture and industry is evaluated in the mega cities of Iran. Data from 683 individuals in public places provided the first civic perception of nanotechnology in Iran. Quantitative statistical analysis on positive or negative points of view demonstrated that Iranian people had general positive opinions on nanotechnology and its application in medicine. They believed that nanomedicine can significantly improve the current methods used in disease treatments, (...) especially for cancer therapy. In general, the responders believed that they would easily accept the use of nanotechnology products and would like increased financial support of the government on nanomedicine and nanotechnology research fields and they showed little anxiety about the possible risks. According to our statistical analysis, three individual characteristics age, education level and career had a direct correlation with the knowledge level of Iranian people on nanotechnology in the mega cities of Iran. (shrink)
“Reasonable hostility” is a norm of communicative conduct initially developed by studying public exchanges in education governance meetings in local U.S. communities. In this paper I consider the norm’s usefulness for and applicability to a U.S. state-level public hearing about a bill to legalize civil unions. Following an explication of reasonable hostility and grounded practical theory, the approach to inquiry that guides my work, I de-scribe Hawaii’s 2009, 18-hour pub-lic hearing and analyze selected segments of it. I show (...) that this par-ticular public hearing raised de-mands for testifiers on the anti-civil union side of the argument that rea-sonable hostility does not do a good job of addressing. Development of a norm of communication conduct for this practice, as well as others, must engage with the culture and time-specific beliefs that a society holds, beliefs that will shape not only how to argue but what may be argued and what must be assumed about particular categories of persons. (shrink)
Several recent anti-obesity campaigns appear to embrace stigmatization of obese individuals as a public health strategy. These approaches seem to be based on the fundamental assumptions that (1) obesity is largely under an individual’s control and (2) stigmatizing obese individuals will motivate them to change their behavior and will also result in successful behavior change. The empirical evidence does not support these assumptions: Although body weight is, to some degree, under individuals’ personal control, there are a range of biopsychosocial (...) barriers that make weight regulation difficult. Furthermore, there is accumulating evidence that stigmatizing obese individuals decreases their motivation to diet, exercise, and lose weight. Public health campaigns should focus on facilitating behavioral change, rather than stigmatizing obese people, and should be grounded in the available empirical evidence. Fundamentally, these campaigns should, first, do no harm. (shrink)
The recent confirmation of the constitutionality of the Obama administration’s Patient Protection and Affordable Care Act (PPACA) by the US Supreme Court has brought to the fore long-standing debates over individual liberty and religious freedom. Advocates of personal liberty are often critical, particularly in the USA, of public health measures which they deem to be overly restrictive of personal choice. In addition to the alleged restrictions of individual freedom of choice when it comes to the question of whether or (...) not to purchase health insurance, opponents to the PPACA also argue that certain requirements of the Act violate the right to freedom of conscience by mandating support for services deemed immoral by religious groups. These issues continue the long running debate surrounding the demands of religious groups for special consideration in the realm of health care provision. In this paper I examine the requirements of the PPACA, and the impacts that religious, and other ideological, exemptions can have on public health, and argue that the exemptions provided for by the PPACA do not in fact impose unreasonable restrictions on religious freedom, but rather concede too much and in so doing endanger public health and some important individual liberties. (shrink)
University of Utrecht, Department of Philosophy, Heidelberglaan 6, 3584 CS Utrecht, The Netherlands. Tel.: +31 (0)30 253 28 74, Email: Thomas.Nys{at}phil.uu.nl ' + u + '@' + d + ' '//--> Abstract Measures in public health care (PHC) seem vulnerable to charges of paternalism: their aim is to protect, restore, or promote people's health, but the public character of these measures seems to leave insufficient room for respect for individual autonomy. This paper wants to explore three challenges (...) to these charges: (i) Measures in PHC are aimed to protect, restore or promote ‘deep autonomy’, (ii) Measures in PHC are directed at the public and, as such, they do show respect for autonomy, and (iii) Some measures in PHC can be justified on grounds of justice and need not be defended as cases of ‘justified paternalism’. Although charges of unjustified paternalism in PHC might still be relevant, we should at least face these different challenges. CiteULike Connotea Del.icio.us What's this? (shrink)
This paper is a survey of the positive and negative aspects of cannabis use from the point of view of the individual on one hand and from the point of view of the society on the other hand. Health, social, and political motives are all discussed, and the best method of harm reduction is analysed. The upshot is that zero tolerance policy is obsolete, and that most individuals would be better off using cannabis rather than other drugs.
Is it possible to interfere with individual decision-making while preserving freedom of choice? The purpose of this article is to assess whether ‘libertarian paternalism’, a set of political and ethical principles derived from the observations of behavioural sciences, can form the basis of a viable framework for the ethical analysis of public health interventions. First, the article situates libertarian libertarianism within the broader context of the law and economics movement. The main tenets of the approach are then presented and (...) particular attention is given to its operationalization through the notion of a ‘nudge’. Essentially, a ‘nudge’ consists in an intervention, which aims to suggest one choice over another by gently steering individual choices in welfare-enhancing directions yet without imposing any significant limit on available choices. Finally, the article concludes that, while it fails as an overreaching framework of ethical analysis, libertarian paternalism nonetheless constitutes a valuable addition to the conceptual toolbox of public health ethics. (shrink)
According to Stephen Holland, the challenges I mention in my original paper can be met, so that, in a way, the problem of paternalism in public health care—which I intended to put into perspective by drawing out some possible justifications for it—returns in all its might and glory. But of course, as Holland observes, I never suggested that my challenges could never be met. I only wanted to point out that for each and every particular public health policy (...) that should come to our attention we should reflect upon these challenges and see whether they could provide reasons for justification. I believe that the discussion is often stalled because these measures—in the absence of individual consent and in their aim to benefit the public's ‘best interests’—seem to be paternalist by default. In my paper, I wanted to call this assumption into question, but never intended to prove that there is no such thing as unjustified paternalism in public health care. Nevertheless, Holland's criticism is very insightful and he has done a lot to clarify my position. However, he also puts me on the spot by urging me to argue to what extent I can meet his rebuttal, and I am very grateful for that opportunity. (shrink)
oise Baylis, 1234 Le Marchant Street, Halifax, Nova Scotia, Canada B3H 3P7. Tel.: (902)-494–2873; Fax: (902)-494-2924; Email: francoise.baylis{at}dal.ca ' + u + '@' + d + ' '//--> . Abstract Recently, there has been a growing interest in public health and public health ethics. Much of this interest has been tied to efforts to draw up national and international plans to deal with a global pandemic. It is common for these plans to state the importance of drawing upon (...) a well-developed ethics framework and we argue that this framework should reflect the values and insights of feminist relational theory. More specifically, we argue that pandemic planning must be squarely situated in the larger realm of public health and that an ethics framework for public health will be one that recognizes the need to pay particular attention to the vulnerability of subpopulations lacking in social and economic power. We propose an ethics framework for public health that builds on the notions of relational personhood (including relational autonomy and social justice) and relational solidarity. In this way, we aim for a public health ethics that, as appropriate, promotes the public interest and the common good. CiteULike Connotea Del.icio.us What's this? (shrink)
PhD, Institute of Public Health, Unit of Medical Philosophy and Clinical Theory, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099 1014 Copenhagen. Tel: +45 30 32 33 63; Email: s.lauridsen{at}pubhealth.ku.dk ' + u + '@' + d + ' '//--> Abstract Citizens’ consent to political decisions is often regarded as a necessary condition of political legitimacy. (...) class='Hi'> Consequently, legitimate allocation of healthcare has seemed almost unattainable in contemporary pluralistic societies. The problem is that citizens do not agree on any single principle governing priorities among groups of patients. The Accountability for Reasonableness (A4R) framework suggests an ingenious solution to this problem of moral disagreement. Rather than advocating any substantive distributive principle, its advocates propose a feasible set of conditions, which, if met by decision makers at the institutional level, provide, so it is promised, legitimate decisions. While we agree that A4R represents an important contribution to the priority-setting debate, we challenge the framework in two respects. First, we argue that A4R, and more specifically the relevance condition of A4R, does not enable healthcare institutions to generally distinguish between relevant and irrelevant reasons for priority-setting. Second, we criticize Daniels’ and Sabin's argument that A4R and deliberative democracy constitute necessary and sufficient conditions of a feasible procedure for setting legitimate limits within healthcare. CiteULike Connotea Del.icio.us What's this?. (shrink)
Center for Humans and Nature, 109 West 77th Street, Suite 2, New York, NY 10024, USA. Tel.: 212 362 7170; Fax: 212 362 9592; Email: brucejennings{at}humansandnature.org ' + u + '@' + d + ' '//--> . Abstract A fundamental question for the ethical foundations of public health concerns the moral justification for limiting or overriding individual liberty. What might justify overriding the individual moral claim to non-interference or to self-realization? This paper argues that the libertarian justification for limiting (...) individual liberty known as the ‘harm principle’ or the ‘Millian paradigm’ is inadequate as a basis of public health ethics and policy. But simply pitting some collectivist value or utilitarian criterion over against individual liberty is not theoretically satisfactory, either. John Stuart Mill himself was not a Millian, in this sense, and his utilitarianism does not pit itself against individual liberty as a situation of balancing conflicting values. A reconsideration of Mill, particularly in light of the later work of Berlin on liberty, points toward a conception of relational liberty that is crucial for public health ethics because it contains within itself the basis for its own moral limitation. CiteULike Connotea Del.icio.us What's this? (shrink)
Centre for Applied Philosophy and Public Ethics (CAPPE), The Australian National University, LPO Box 8260, ANU, Canberra ACT 2601, Australia. Email: michael.selgelid{at}anu.edu.au ' + u + '@' + d + ' '//--> . Home page: http://www.cappe.edu.au/staff/michael-selgelid.htm Abstract This article advocates the development of a moderate pluralist theory of political philosophy that recognizes that utility, liberty and (...) equality are legitimate, independent social values and that none should have absolute priority over the others. Inter alia, such a theory would provide a principled means for striking a balance, or making trade-offs, between these values in cases of conflict. Recent developments in public health ethics have made progress in thinking about how to make trade-offs between liberty and utility in particular. While public health ethicists often claim that the least restrictive alternative should be used to achieve the public health goal in question, I argue that a plausible but under-recognized idea is that the least restrictive alternative might sometimes involve improvement of global health via redistributive taxation—i.e., rather than coercive social distancing measures. I conclude by demonstrating that the proportionality principle leaves open the question of when exactly utility outweighs liberty or vice versa—and I argue that, rather than speaking about the morality of liberty-infringing public health interventions in categorical/binary terms, it would be more fruitful and realistic to think and speak about the degree to which a liberty-infringing public health intervention is morally appropriate. CiteULike Connotea Del.icio.us What's this?. (shrink)
Evaluating public health measures is one of the central tasks in public health ethics. Some public health measures incur the charge that they are paternalistic in an objectionable way. In a recent intriguing contribution to this journal, Thomas Nys responds to this complaint by setting out three challenges to be met if the charge is to be made good. The first challenge is that putatively objectionable public health measures in fact preserve autonomy; the second is that (...) autonomy is not undermined by measures that are the upshot of democratic processes; the third is that it is a mistake to charge measures intended to benefit others with being objectionably paternalistic. Nys's explicit aim in presenting these challenges is not to show that the charge of paternalism in public health is never sound, but to stimulate further discussion. My paper takes up this invitation by responding to each of the challenges Nys presents, including discussing where they fail and identifying which succeed. (shrink)
American healthcare -- Bioterror and bioart -- State of emergency -- Licensed to torture -- Hunger strikes -- War -- Cancer -- Drug dealing -- Toxic tinkering -- Abortion -- Culture of death -- Patient safety -- Global health -- Statue of security -- Pandemic fear -- Bioidentifiers -- Genetic genocide.
Boehl Chair of Law and Medicine and Director of the Institute for Bioethics, Health Policy and Law, University of Louisville School of Medicine, 501 East Broadway # 310, Louisville, Kentucky 40202, USA. Tel.: 502 852 4980; Fax: 502 852 4963; Email: mark.rothstein{at}louisville.edu ' + u + '@' + d + ' '//--> Abstract In his article in this issue, Daniel Goldberg advocates a broad definition of public health and expressly rejects the narrow definition of public health I proposed (...) in a 2002 article. Goldberg asserts that public health should include all of the root causes of ill health in populations. Such a definition, however, would include within public health war, famine, crime, illiteracy and numerous other conditions on which public health professionals and agencies lack the resources, expertise and public support to act. The appropriate definition explicitly recognizes that public health is a legal term of art referring to specifically authorized activities by public officials to protect, promote and improve population health. CiteULike Connotea Del.icio.us What's this? (shrink)
In this article, we analyse content from two recent reports to examine how a public health framework to cognitive enhancement is emerging. We find that, in several areas, these reports provide population-level arguments both for and against the use of cognitive enhancers. In discussing these arguments, we look at how these reports are indicative of potentially innovative frameworks—epidemiological, risk/benefit and socio-historical—by which to explore the public health impact of cognitive enhancement. Finally, we argue that these reports are suggestive (...) of both tensions between the bioethical and public health approaches and are also indicative of how these two frameworks can, in part, be seen as complementary. (shrink)
If ‘community’ is the answer, what is the problem? While questions undoubtedly arise in allocating resources to public health, such as ‘how much?’ and ‘to whom?’, we already have answers based on (i) the observation that disease and illness are bad, (ii) views of justice and fairness and (iii) an appreciation of market failure. What does the concept of community add to the existing answers? Not nothing, I shall argue, but not much either. In some cases, health providers should (...) take advantage of ties of community to deliver services more effectively. The desire to preserve communities may have some minor implications for devolved health care funding. The value of community may set some limits to inequalities in access to health care. That’s about it. I do consider some other claims of behalf of the concept, e.g. that people would not support justice in health care without a sense of community; but I don’t find these claims very plausible. Finally, I point out some ways in which communities can be damaged by the promotion of public health understood as population health. (shrink)
Corresponding Author, Health Policy & Ethics Fellow, Chronic Disease Prevention & Control Research Center, Department of Medicine, Baylor College of Medicine, 1709 Dryden, Suite 1025, Houston, TX 77030, USA. Tel.: 713.798.5482; Fax: 713 798 3990; Email: danielg{at}bcm.edu ' + u + '@' + d + ' '//--> . Abstract This article defends a broad model of public health, one that specifically addresses the social epidemiologic research suggesting that social conditions are primary determinants of health. The article proceeds by critiquing (...) one of the strongest arguments in favor of a narrow model, advanced by Mark Rothstein. The critique sets up the argument that a model of public health that does not address what actually causes health and disease is unlikely to improve public health. Assessing the substantial evidence regarding the social determinants of health, the article engages the policy paradox that precludes utopian prescriptions but demands more than mere expedience. CiteULike Connotea Del.icio.us What's this? (shrink)
Making research data readily accessible during a public health emergency can have profound effects on our response capabilities. The moral milieu of this data sharing has not yet been adequately explored. This article explores the foundation and nature of a duty, if any, that researchers have to share data, specifically in the context of public health emergencies. There are three notable reasons that stand in opposition to a duty to share one’s data, relating to: (i) data property and (...) ownership, (ii) just distribution of benefits and burdens and (iii) the contemporary ethos of science. We argue each reason can be successfully met with corresponding rationale in favour of data sharing. Further support for data sharing has been echoed in policies of health agencies, funding bodies and academic institutions; in documents on the ethical conduct of biomedical research; and in discussions on the nature of public health. From this, we ascertain that sharing data is the morally sound default position. This article then highlights the key roles reciprocity and solidarity play in supporting the practice of data sharing. We conclude with recommendations to regard public health research data as a common-pool resource in order to build a framework for stable data sharing management. (shrink)
Some theorists, worried about liberalism’s potential as a foundation for public health ethics, suggest that republicanism provides a better background of justification for public health policies, interventions, etc. In this article, this suggestion is put to the test, and it is argued that (i) contemporary (civic) republicanism and liberalism are not nearly as opposed as it is sometimes suggested, and that (ii) the kind of republicanism which one leading scholar in the field, Bruce Jennings, as an alternative to (...) liberalism, does not reflect the contemporary understanding of republicanism as held by, e.g. Phillip Pettit et al. (shrink)
Nuffield Council on Bioethics, London * Corresponding author: Nuffield Council on Bioethics, 28 Bedford Square, London WC1B 3JS, UK. Email: hschmidt{at}nuffieldbioethics.org ' + u + '@' + d + ' '//--> Abstract In November 2007, the Nuffield Council on Bioethics published the report Public Health: Ethical Issues . While the report has been welcomed by a wide range of stakeholders, there has also been some criticism. First, it has been suggested that it is not clear why, in developing its (...) ‘stewardship model’, the Council felt the need to go beyond the liberal position developed by John Stuart Mill—what is it that the stewardship model adds? Second, it is suggested that the Report is confused about the concept of paternalism. Third, it is argued that the discussion of the concept of stewardship is lacking in detail and substance. We clarify the Working Party's thinking regarding these three areas, which demonstrates the robustness of the framework set out in the report. CiteULike Connotea Del.icio.us What's this? (shrink)
Finding an effective microbicide that could substantially lower women’s risk of acquiring HIV infection is an ethical imperative. Women and girls continue to be disproportionally affected by HIV in sub-Saharan Africa. Ethics guidelines for conducting preventive HIV microbicide trials call for steps that intertwine biomedical research and public health. Ethical considerations include adequate studies of the safety of microbicides, the use of placebo controls in future trials once a microbicide is shown to be effective, whether leftover microbicide from a (...) trial that demonstrated efficacy should be made available to the public or used in the control group of a future trial, what preventive measures and treatment should be provided for trial participants during and after the research, and what constitute ‘fair benefits’ to the community or country when a trial is completed. The Global Campaign for Microbicides conducted a study of the benefits being provided to participants in microbicide trials and others, and found substantial evidence that researchers and sponsors are meeting the obligations stated in ethical guidelines. A cautionary tale of an HIV prevention trial that was prematurely halted demonstrates the need for engagement with the community where trials are carried out. (shrink)
Dr Thomas Stockmann, the protagonist of Ibsen's play, An Enemy of the People , discovers a serious health threat in the Baths of his Norwegian town. The Baths have been marketed as a health resort to lure visitors. Dr Stockmann alerts officials about the problem and assumes that they will close the Baths until it is corrected. He is met with fierce resistance, however. His brother, the town's mayor, favors keeping the Baths open and correcting the problem gradually. He advances (...) multiple arguments that appeal to the economic interests of the town and Thomas's role-related obligation as a citizen. His wife, Katherine, wants him to cooperate with the mayor. She marshals several arguments that appeal to his obligations as a father. This paper reconstructs and examines the competing arguments, shows how Ibsen's play has both contemporary relevance and moral depth, and demonstrates how Dr Stockmann's responses can be interpreted as an argument that complying with his duties to protect the public health do not force him to renege on his core commitments as a parent and as a citizen. (shrink)
Obesity is a public health problem influenced by behavioral patterns that span an ecological spectrum of individual-level factors, social network factors and environmental factors. Both individual and environmental approaches necessarily include significant influences from social networks, but how and under what conditions social networks influence behavior change is often not clearly mapped out either in the obesity literature or in many intervention designs. In this paper, we provide an analysis of recent empirical work in obesity research that explicates social (...) network influences on eating behaviors. We argue that a relational rather than individualistic view of personhood should help us better understand the content and context of social network relations that inform health behavior choices. We introduce the concept of ‘identity-constitutive affiliations’ as the glue that binds these social relationships together. Finally, we outline the implications for public health ethics in the development of effective interventions to address overweight and obesity, leveraging the content and context of social network ties to reinforce healthy (or alter unhealthy) eating. More complex treatment of positive and negative behaviors stemming from social network connections should lead to more comprehensive theoretical models of health behavior change and more effective public health interventions. (shrink)
Presentazione del curatore italiano (C.Corradetti): È possibile conciliare il pluralismo culturale con la dimensione pubblica della deliberazione? Partendo dall’analisi critica di Rawls e Habermas, James Bohman offre una risposta innovativa alla questione dell’accordo democratico. In tale proposta, parallelamente al rigetto di soluzioni meramente strategiche, viene riabilitata la nozione di compromesso morale nel quadro di un accordo normativo. Mantenendo fede ad una prospettiva composta da elementi normativi e fattuali, l’autore si propone di ampliare le opportunità democratiche nella riconciliazione tra conflitti culturali (...) profondi propri delle società contemporanee. L’elemento civico partecipativo risulta essere dunque una componente essenziale per la produzione di una sfera pubblica vibrante. Ne emerge una ricostruzione convincente volta non solo a respingere le critiche degli scettici sulle reali possibilità d’inclusività democratica, ma diretta soprattutto a suggerire un più efficace modello deliberativo per la garanzia della stabilità sociale. Questo testo è diventato ormai un riferimento internazionale classico nella discussione sul tema della deliberazione pubblica. L’autore ha inoltre sviluppato in ambito post-nazionale il suo modello deliberativo senza tuttavia ridiscutere i fondamenti concettuali della sua proposta teorica qui enunciati.Vista la rilevanza del tema e considerata la centralità del testo proposto, sembrerebbe dunque auspicabile rendere il testo disponibile anche al lettore italiano. (shrink)
This paper defends a distinctly liberal approach to public health ethics and replies to possible objections. In particular, I look at a set of recent proposals aiming to revise and expand liberalism in light of public health's rationale and epidemiological findings. I argue that they fail to provide a sociologically informed version of liberalism. Instead, they rest on an implicit normative premise about the value of health, which I show to be invalid. I then make explicit the unobvious, (...) republican background of these proposals. Finally, I expand on the liberal understanding of freedom as non-interference and show its advantages over the republican alternative of freedom as non-domination within the context of public health. The views of freedom I discuss in the paper do not overlap with the classical distinction between negative and positive freedom. In addition, my account differentiates the concepts of freedom and autonomy and does not rule out substantive accounts of the latter. Nor does it confine political liberalism to an essentially procedural form. (shrink)
There is a growing movement to increase access to palliative care by declaring it a human right. Calls for such a right—in the form of articles in the healthcare literature and pleas to the United Nations and World Health Organization—rarely define crucial concepts involved in such a declaration, in particular ‘palliative care’ and ‘human right’. This paper explores how such concepts might be more fully developed, the difficulties in using a human rights approach to promote palliative care, and the relevance (...) of such an enterprise to public health ethics. (shrink)
In this article, we address the relevance of J.S. Mill’s political philosophy for a framework of public health ethics. In contrast to some readings of Mill, we reject the view that in the formulation of public policies liberties of all kinds enjoy an equal presumption in their favor. We argue that Mill also rejects this view and discuss the distinction that Mill makes between three kinds of liberty interests: interests that are immune from state interference; interests that enjoy (...) a presumption in favor of liberty; and interests that enjoy no such presumption. We argue that what is of focal importance for Mill in protecting liberty is captured by the essential role that the value of self-determination plays in human well-being. Finally, we make the case for the plausibility of a more complex and nuanced Millian framework for public health ethics that would modify how the balancing of some liberty and public health interests should proceed by taking the thumb off the liberty end of the scale. Mill’s arguments and the legacy of liberalism support certain forms of state interference with marketplace liberties for the sake of public health objectives without any presumption in favor of liberty. (shrink)
This article draws on scientific explanations of obesity to motivate the creation of a system of paternalistic public health interventions into the obesity epidemic. Libertarian paternalists argue that paternalism is warranted in light of the cognitive limits of human decision-making abilities. There are further, specific biological limits on our capacity to choose and maintain a healthy diet. These biological facts strengthen the general motivation for libertarian paternalism. As a consequence, the creation of a system of paternalistic public health (...) interventions into the obesity epidemic is warranted. (shrink)
The Harvard University Program in Ethics and Health, 651 Huntington Avenue, 6th floor c/o HSPH, François Xavier Bagnoud Building, Boston, MA 02115, USA. Tel.: +1 617 4327244; Email: andras_miklos{at}hms.harvard.edu ' + u + '@' + d + ' '//--> Abstract When exercising their public health powers, states claim various rights against their subjects and aliens. The paper considers whether public health considerations can help justify some of these rights, and explores some constraints on the justificatory force of (...) class='Hi'>public health considerations. I outline two arguments about the moral grounds for states’ rights with regard to public health. The principle of fairness emphasizes that those who benefit from public health measures ought to contribute their fair share in upholding them. Alternatively, states’ rights might be justified by a natural duty of justice to uphold and not to obstruct institutions implementing public health policies. I indicate some reasons for preferring the latter justification. I further argue that the assignment of some rights to states via public health-based justification is undermined on several counts. Domestic political institutions cannot effectively perform some of their functions in protecting public health. Furthermore, transborder public health threats pose collective action problems at the global level. Finally, concerns about human rights work against the assignment of some rights to states. I conclude by arguing that these concerns call for global coordination, and that some rights claimed by states ought instead to be assigned to global institutions. CiteULike Connotea Del.icio.us What's this? (shrink)
Comprehensive Biomedical Research Centre and Centre for Philosophy, Justice and Health, UCL, First Floor, Charles Bell House, 67–73 Riding House Street, London W1W 7EJ, UK. Tel.: +44 (0)20 7679 9417; Fax: +44 (0)20 7679 9426; Email: james-gs.wilson{at}ucl.ac.uk ' + u + '@' + d + ' '//--> . Abstract This paper aims to shed some light on the difficulties we face in constructing a generally acceptable normative framework for thinking about public health. It argues that there are three factors (...) that combine to make theorising about public health difficult, and which when taken together defeat simplistic top-down and bottom-up approaches to the design of public health policies. The first factor is the problem of complex systems, namely that the distribution of health both affects and is affected by the distribution of other goods. The second is the difficulty of defining the goals of public health: we still need to get clear about what we should mean by health in this context, and what the goals of public health should be. The third is that we stand in need of an account of how important health is relative to the importance of other goods that a just society should be trying to secure for its citizens. The paper argues that these problems should lead us to abandon the search for a ‘one-size fits all’ normative framework for thinking about public health. Rather, different approaches will be appropriate at different levels of abstraction. CiteULike Connotea Del.icio.us What's this? (shrink)
For the last several decades, philosophers have wrestled with the proper place of religion in liberal societies. Usually, the debates among these philosophers have started with the articulation of various conceptions of liberalism and then proceeded to locate religion in the context of these conceptions. In the process, however, too little attention has been paid to the way religion is conceived. Drawing on the work of Robert Audi and Nicholas Wolterstorff, two scholars who are often read as holding opposing views (...) on these issues, I argue that, for the purposes of their argument about liberalism, both have implicitly accepted a concept of religion that has come under severe attack in recent work on the subject. Namely, they have accepted a concept of religion that identifies religion primarily with belief, ritual practice, and ecclesial institutions. Following recent scholarship, I suggest that religion is better conceived as a kind of culture. To conclude the essay, I gesture toward what the beginnings of a re-visioned debate about religion and liberal society might look like if one started from this revised conception of religion. (shrink)
Social Justice and Political Change, involves the collaboration of thirty social scientists in twelve countries, and represents broad-ranging comparative ...
While promoting population health has been the classic goal of public health practice and policy, in recent decades, new objectives in terms of autonomy and equality have been introduced. These different goals are analysed, and it is demonstrated how they may conflict severly in several ways, leaving serious unclarities both regarding the normative issue of what goal should be pursued by public health, what that implies in practical terms, and the descriptive issue of what goal that actually is (...) pursued in different contexts. A basic conflict of perspective is handled by integrating the ideas of public health striving for health-related autonomy and equality, resulting in a prioritarian oriented population approach to health-related autonomy. This integrated goal is demonstrated to constrain itself in several ways attractive from the point of view of the classic goal, but several serious problems remain. For this reason, a model where all of the three goals are integrated into one coherent structure where they can be assigned varying degrees of importance relative to the level of population health is described. It is argued that this model avoids the problems set out earlier, and is actually normatively preferable to the classic goal alone. It is furthermore argued that the model may be employed as a useful tool for descriptive ethics, as well as a vehicle for international harmonisation of public health policies. A number of practical implications regarding, e.g., the importance of respecting autonomy and the allocation of public health resources are noted, as are a battery of questions for further research. (shrink)
This article aims to contribute to the application of ethical frameworks to public health policy. In particular, the article considers the use of the Nuffield Council on Bioethics stewardship model, as an applied framework for the evaluation of evidence within public health policymaking. The ‘Stewardship framework’ was applied to a policy proposal to restrict marketing of food and beverages to children. Reflections on applying the stewardship model as a framework are provided. The article concludes that the questions used (...) to apply the stewardship model usefully introduced ethical considerations into the evidence review. However, the real value will likely come from the type of policy process within which the framework is used, identifying competing value positions and capturing local value requirements. (shrink)
Many legal scholars well recognize that, in some instances, support for a law or policy may be primarily because of its expressive function, i.e. the statements it makes about underlying values. In these cases, the expressive content of a law or policy may actually overshadow its central purpose. Examples of this phenomenon, according to Cass Sunstein, include, for example, regulations against hate speech in the USA. He suggests that achieving the consequence (prohibiting hateful speech against certain groups) may not be (...) the real focus (central purpose) of the law. Rather, the real focus is on the social meaning of these regulations—that bigotry is unacceptable in a liberal society. In this way, a particular law or policy can operate on many levels—while aiming to achieve a particular objective or behavior, it can also be a valuable tool for achieving other important social goals through its expressive function. This article applies this insight to the realm of public health policy, with particular attention to the case of pandemic planning, and suggests that public health policy and its overall goals may be well-served by deliberate regard for, and appropriate utilization of, the expressive function. (shrink)
Public health communications often attempt to persuade their audience to adopt a particular belief or pursue a particular course of action. To a large extent, the ethical defensibility of persuasion appears to be assumed by public health practitioners; however, a handful of academic treatments have called into question the ethical defensibility of persuasive risk- and health communication. In addition, the widespread use of persuasive tactics in public health communications warrants a close look at their ethical status, irrespective (...) of previous critiques. In this article, we review some ethical objections previously advanced against the use of persuasion in public health communications, and also consider some novel but potentially relevant objections. We conclude that persuasion is ethically problematic in some circumstances and attempt to clarify what these circumstances are. However, whereas persuasion may be ethically problematic in some circumstances, it need not be viewed as intrinsically problematic. (shrink)
Conventional and well-established guidelines for the ethical conduct of clinical research are necessary but not sufficient for addressing research dilemmas related to public health research. There is a particular need for a public health ethics framework when, in the face of an epidemic, research is urgently needed to promote the common good. While there is limited experience in the use of a public health ethics framework, the value and potential of such an approach is increasingly being appreciated. (...) Here we use two examples of adolescent women as potential candidates for participation in microbicide trials to illustrate how ethical decisions for public health research can be enhanced by drawing on both traditional research ethics guidance, and the emerging framework for public health ethics. (shrink)
WHO suggests mental ill health in terms of depression to be the highest ranking disease problem in the developed world in 2020–2030 and claims a public health approach to be the most appropriate response. But some argue that the alarming reports on mental ill health have their ground in the methods of inquiry themselves and refer to medicalization as an important issue. The aim of this article is to explore and illuminate the issue of what is meant by mental (...) health and mental ill health and what it means that mental ill health is a major public health problem. Basically, two understandings and aspects of public health exist: a ‘reductionist’ and a ‘holistic’ with connections to different theories of health. These diverging understandings may lead to quite different public health responses, and they may have different consequences with regard to medicalization. It is concluded that we need more clearly elaborated ways to think about public health so that the increased attention to mental ill health as a public health problem does not in itself lead to medicalization in terms of just medical treatment. Otherwise, we risk losing the importance of public health as an overarching social and political instrument. (shrink)
Traditional Chinese culture, Confucianism, in particular, has a non-individualist conception of what it is to be human. It conceives of people fundamentally as members of social groups—specifically, the family, the clan, the political community and the state—not as atomic individuals as perceived in modern society. The communist ideology since the middle of the last century also emphasizes the significance of ‘the common good’ of the state which describes a specific ‘good’ that is shared and beneficial for all (or most) members (...) of a given community. Nevertheless, marketization and decentralization in China today have significantly challenged the notion of a state-oriented community that directly impacts China's healthcare system, beginning with the dismantling of the rural collectives and state-owned enterprises as part of the reform and opening process. This article will address healthcare challenges in China today, examining the conceptual/ethical issues raised by public healthcare, and contending that public health concerns should go beyond the dichotomy between individualism and collectivism. The article will argue that the family-oriented model of Confucianism offers an alternative way to look at what constitute a community and common goods. The Confucian approach to ethics is relevant to healthcare today. For example, it will be much easier to find a shared idea of common good in terms of complicated issues like healthcare; it would make sense to give a larger role to families via family savings accounts, and not have everything determined by the government. (shrink)
In 2007, the Ethics and Governance Council of the UK Biobank commissioned a Report on ‘Concepts of Public Good and Pubic Interest in Access Policies’. This study considered the Biobank’s role as a ‘public good’ in respect to supporting and promoting health throughout society. However, the conditions under which access by third parties to UK Biobank are justified in the public interest have not been well considered. In this article, I propose to analyse the conditions that should (...) allow such access. My argument develops UK Biobank’s function as a ‘public good’ and in terms of its responsibilities as a public health institution; both to protect the rights of the participants and in having a role in reinforcing public goals. Although these two tasks may conflict, it is possible that resolute opposition to some third-party access demands—if properly justified in terms of a public interest—will be damaging to, rather than protective of, participants’ rights. To illustrate my argument, I consider the appropriate response to an extraordinary public emergency , such as a serious criminal investigation or disaster response, in terms of an ethical access policy. (shrink)
This comment on the case presented in ‘Cholera and Nothing More’ argues that the physicians at this public-health centre did not have an ordinary clinician's obligations to promote the health of the people who came to them for care, as they were instead set up to serve a laudable and urgent public-health goal, namely, controlling a cholera outbreak. It argues that, nonetheless, these physicians did have some limited moral duties to care for other diseases they encountered—some ancillary-care duties—arising (...) from their voluntarily entering into a kind of intimate relationship with the patients they took in, one in which those patients effectively waive certain rights to bodily and medical privacy. (shrink)
Vaccination programmes against infectious diseases aim to protect individuals from serious illness but also offer collective protection once a sufficient number of people have been immunized. This so-called ‘herd immunity’ is important for individuals who, for health reasons, cannot be immunized or who respond less well to vaccines. For these individuals, it is pivotal that others establish group protection. However, herd immunity can be compromised when people deliberately decide not to be immunized and benefit from the herd’s protection. These agents (...) are often referred to as free riders: their omissions are deemed to be unfair to those who do contribute to the collective’s health. This article addresses the unfairness of such ‘free riding’. An argument by Garett Cullity is examined, which asserts that the unfairness of moral free riding lies neither in one’s intentions, nor in one’s reluctance to embrace a public good. This argument offers a strong basis for justifiably arguing that free riding is unfair. However, it is then argued that other considerations also need to be taken into account before simply holding free riding against non-compliers. (shrink)
O artigo reexamina as concepções habermasianas de política deliberativa e democracia procedimental à luz de outras teorias deliberativas, de forma a explorar as suas semelhanças e diferenças e investigar o quanto devem à ideia de razão pública e as implicações práticas daquela ideia.
Machine generated contents note: Preface; Introduction Angus Dawson; Part I. Concepts: 1. Resetting the parameters: public health as the foundation for public health ethics Angus Dawson; 2. Health, disease and the goal of public health Bengt Brülde; 3. Selective reproduction, eugenics and public health Stephen Wilkinson; 4. Risk and precaution Stephen John; Part II. Issues: 5. Smoking, health and ethics Richard Ashcroft; 6. Infectious disease control Marcel Verweij; 7. Population screening Ainsley Newson; 8. Vaccination ethics Angus (...) Dawson; 9. Environment, ethics and public health: the climate change dilemma Anthony Kessel and Carolyn Stephens; 10. Public health research ethics: is non-exploitation the new principle for population-based research ethics? John McMillan; 11. Equity and population health: toward a broader bioethics agenda Norman Daniels; 12. Health inequities James Wilson; Index. (shrink)
Partly in response to rising rates of obesity, many governments have published healthy eating advice. Focusing on health advice related to the consumption of animal products (APs), I argue that the individualistic paradigm that prevails must be replaced by a radically new approach that emphasizes the duty of all human beings to restrict their negative “Global Health Impacts” (GHIs). If they take human rights seriously, many governments from nations with relatively large negative GHIs—including the Australian example provided here—must develop strategies (...) to reduce their citizens’ negative GHIs. As the negative GHIs associated with the consumption of many APs are excessive, it is my view that many governments ought to adopt a qualified ban on the consumption of APs. (shrink)
While Billy Budd's beauty has often been connected to his innocence and his moral goodness, the significance of the musical character of his beauty—what I will argue is the site of a struggle for political expression—has not been remarked upon by commentators of Melville's novella. It has, however, been deeply explored by Britten's opera. Music has often been situated at, or just beyond, the limits of communication; it has served as a medium of the ineffable, of unsaid and unsayable truths (...) (and lies), of an expressive power beyond language and reason. It is this expressive but communicatively problematic role that Billy embodies and that Billy Budd sets into political motion. In this essay, I would like to suggest that Billy's musical beauty can only be fully appreciated, and assumes full significance, when considered within the context of the various conceptions of beauty, and corresponding conceptions of authority, presented in the novella and in the opera. In particular, I will argue that Billy's beauty is a modern one that calls for the active participation of its audience. (shrink)
