Informed decision-making (IDM) is considered an important ethical and legal requirement for population-based screening. Governments offering such screening have a duty to enable invitees to make informed decisions regarding participation. Various views exist on how to define and measure IDM in different screening programmes. In this paper we first address the question which components should be part of IDM in the context of cancer screening. Departing from two diverging interpretations of the value of autonomy—as a right and as an ideal—we (...) describe how this value is operationalized in the practice of informed consent in medicine and translate this to IDM in population-based cancer screening. Next, we specify components of IDM, which is voluntariness and the requirements of disclosure and understanding. We argue that whereas disclosure should contain all information considered relevant in order to enable authentic IDM, understanding of basic information is sufficient for a valid IDM. In the second part of the paper we apply the capability approach in order to argue for the responsibility of the government to warrant equal and real opportunities for invitees for IDM. We argue that additional conditions beyond mere provision of information are needed in order to do so. (shrink)

From a moral point of view, what arguments are there for and against seeking COVID-19 vaccination? Can it be morally permissible to require (parts of) a population to receive a vaccine? The present paper adopts a perspective of virtue ethics and argues both that it is morally right for an individual virtuous moral agent to seek COVID-19 vaccination and for a virtuous ruler to impose mandatory vaccinations on her population.We begin by first presenting virtue ethics and the current vaccine controversy. (...) Second, we examine whether a virtuous individual should get vaccinated. Third, we consider whether, from a moral point of view, it is right for a ruler to impose mandatory vaccinations on her citizens. Fourth, we answer some objections to our argument. Finally, we conclude that virtue ethical considerations warrant both the individual choice of getting vaccinated and mandatory vaccinations against COVID-19. (shrink)

School closure is one of the most debated measures undertaken to contain the spread of the Coronavirus disease (COVID-19) pandemic. The pandemic has devastating health and socio-economic effects and must be contained, but schools play a vital role in present and future well-being, capabilities and health of children. We examine the detrimental consequences of both the closure and reopening of schools, by focusing on inequalities in the challenges affecting children and their families. This paper is grounded on Irish and Italian (...) data from a multi-national longitudinal qualitative interview study. Research participants articulated a variety of issues and challenges that highlight inequalities in access to education during school closures, in the supportiveness of home setting, and in school preparedness to reopen, often mirroring or exacerbating pre-existing inequalities. The reported unequal lived experiences indicate that some harms are actionable, and already suggest some potential harm mitigation strategies. We conclude by advocating for enhanced public consultation to help mitigate the consequences of public dilemmas in general, and to help detect and tackle inadequacies and inequalities for school children through and beyond the pandemic, by learning from the experience of the concerned actors. (shrink)

Firearm violence in the United States produces over 36,000 deaths and 74,000 sustained firearm-related injuries yearly. The paper describes the burden of firearm violence with emphasis on the disproportionate burden on children, racial/ethnic minorities, women and the healthcare system. Second, this paper identifies factors that could mitigate the burden of firearm violence by applying a blend of key ethical theories to support population level interventions and recommendations that may restrict individual rights. Such recommendations can further support targeted research to inform (...) and implement interventions, policies and laws related to firearm access and use, in order to significantly reduce the burden of firearm violence on individuals, health care systems, vulnerable populations and society-at-large. By incorporating a blended public health ethics to address firearm violence, we propose a balance between societal obligations and individual rights and privileges. (shrink)

The COVID-19 pandemic has highlighted the question, ‘What do we owe each other as members of a global community during a global health crisis?’ In tandem, it has raised underlying concerns about how we should prepare for the next infectious disease outbreak and what we owe to people in other countries during normal times. While the prevailing bioethics literature addresses these questions drawing on values and concepts prominent in the global north, this paper articulates responses prominent in sub-Saharan Africa. The (...) paper first introduces a figurative ‘global health village’ to orient readers to African traditional thought. Next, it considers ethical requirements for governing a global health village, drawing on the ethic of ubuntu to formulate African renderings of solidarity, relational justice and sufficiency. The final section of the paper uses these values to critique current approaches, including COVAX, the vaccines pillar of the Access to COVID-19 Tools (ACT) accelerator, and a proposed international Pandemic Treaty. It proposes a path forward that better realizes ubuntu in global health. (shrink)

Patient referral management is an integral part of clinical practice. However, in low-resource settings, referrals are often delayed. The World Health Organization categorizes three types of referral delays; delay in seeking care, in reaching care and in receiving care. Using two case studies of maternal referrals (from a low-resource state in India), this article shows how a culture of downstream blaming permeates referral practice in India. With no referral guidelines to follow, providers in higher-facilities evaluate the clinical decision-making of their (...) peers in lower-facilities based on patient outcome, not on objective measures. The fear of punitive action for an unfavorable maternal outcome is a larger driving factor than patient safety. The article argues for the need to formulate an ecosystem where patient responsibility is shared across the health system. In conclusion, it discusses possible solutions which can bridge communication and information gap between referring facilities. (shrink)

Mobile health (mHealth) apps for self-monitoring increasingly gain relevance for public health. As a mobile technology, they promote individual participation in health monitoring with the aim of disease prevention and the mitigation of health risks. In this paper, I argue that users of mHealth apps must engage in value trade-offs concerning their fundamental dimensions of well-being when using mobile health apps for the self-monitoring of health parameters. I particularly focus on trade-offs regarding the user’s self-determination as well as their capacity (...) to form personal attachments. Depending on the user’s level of advantage or disadvantage, value trade-offs can pose a threat to the users’ sufficient fulfillment of the dimensions of well-being. As such, value trade-offs can entrench existing structural injustices and prevent disadvantaged users to benefit from this technology. I argue that value trade-offs are, to some, a type of injustice that can drive disadvantaged users away from a sufficiency threshold of well-being, risk users to fall below the threshold, or have an accumulative effect on different dimensions of the user’s well-being. (shrink)

The novel coronavirus (SARS-CoV-2) pandemic has refocused attention on the issue of mandatory vaccination. Some have suggested that vaccines ought to be mandatory, while others propose more moderate alternatives, such as incentives. This piece surveys a range of possible interventions, ranging from mandates through to education. All may have their place, depending on circumstances. However, it is worth clarifying the options available to policymakers, since there is sometimes confusion over whether a particular policy constitutes a mandate or not. Further, I (...) illustrate a different kind of alternative to mandatory vaccination. Rather than seeking less coercive alternatives to a mandate, we might instead employ an alternative mandate, which requires people to do something less than get vaccinated. For instance, we might merely require people to attend an appointment at a vaccine clinic. Whether this mandatory attendance policy is justified will depend on specific circumstances, but it represents another way to promote vaccination, without mandating it. In some cases, this may represent an appropriate balance between promoting public health goals and respecting individual liberty. (shrink)

For contagious diseases like measles a successful immunization program can result in herd protection. Small outbreaks may still occur but fade out soon, because the possibilities for the pathogen to spread in the ‘herd’ are very small. This implies that people who refuse to participate in such a program will still benefit from the protection it offers, but they don’t do their part in maintaining protection. Isn’t that a case of freeriding—and isn’t that unfair towards all the people who do (...) collaborate? If so, that might be considered an additional ground for making vaccination mandatory or compulsory.In this paper I argue that vaccination refusal can be considered as freeriding, but that this might not be unfair. The public good of herd protection is a peculiar public good because it supervenes on private benefits that are enjoyed by all who do opt for vaccination. For vaccinated individuals, the additional benefit of herd protection comes about, as it were, for free, and hence they can’t complain that others benefit without sharing in the burdens. There are however still other grounds for making vaccination compulsory or at least for seeing refusal as a morally wrong choice. (shrink)

Hassoun argues that the poor in the world have a right to health and that the Global Health Impact Index provides consumers in well-off countries with the opportunity to ensure that more people have access to essential medicines. Because of this, these consumers would be ethically obliged to purchase Global Health Impact Index-labeled products in the face of existing global inequalities. In presenting her argument, Hassoun rejects the so-called democratic account of ethical consumption in favor of the positive change account. (...) Two versions of the democratic change account are relevant. One underscores the importance of democratic procedures and institutions, while the other stresses our fundamental moral equality. While at least one prominent institutionalist account has problems, revised versions would be less vulnerable to Hassoun’s counterexamples. Furthermore, institutionalist accounts come with the epistemological gains from democratic procedures and deliberations, which may be especially important under uncertainty. Finally, and perhaps more challenging for the Global Health Impact index project, this measure may place the burden unfairly on those who need to buy medicines. This is a pivotal insight from the non-institutionalist version of the democratic account of ethical consumption. (shrink)

The core aims of the Global Health Impact Project include incentivizing pharmaceutical companies for socially conscious production and promoting socially conscious consumption among consumers. Its backbone is a metric that computes the amount of illness burden alleviated by a pharmaceutical drug. This essay aims to assess the connection between values and numbers in the Global Health Impact Project. Specifically, I concentrate on two issues, the anonymity of illness burden and the distribution of health benefits. The former issue asks whether we (...) should treat the illness burden of every person the same. The latter issue asks among whom health benefits should be fairly distributed. Examination of these issues begs for clarification of some of the key concepts of the Global Health Impact Project, such as the definition of essential medicines and the significance of national borders. Although this essay focuses on the two particular metric issues in the Global Health Impact Project, its core argument is applicable to other metrics for ethically motivated initiatives—to construct a metric for an ethically motivated initiative, it is not only important to articulate underlying concepts and values, but it is also important to operationalize them, so they are consistently reflected in the metric. (shrink)

Emerging parallel to long-standing, academic and policy inquiries on personal responsibility for health is the empirical assessment of lay persons’ views. Yet, previous studies rarely explored personal responsibility for health among lay persons as dynamic societal values. We sought to explore lay persons’ views on personal responsibility for health using the Fairness Dialogues, a method for lay persons to deliberate equity issues in health and health care through a small group dialogue using a hypothetical scenario. We conducted two 2-h Fairness (...) Dialogues sessions (n = 15 in total) in Nova Scotia, Canada. We analyzed data using thematic analysis. Our analysis showed that personal choice played an important role in participants’ thinking about health. Underlying the concept of personal choice was considerations of freedom and societal debt. In participants’ minds, personal and social responsibilities co-existed and they were unwilling to determine health care priority based on personal responsibility. The Fairness Dialogues is a promising deliberative method to explore lay persons’ views as dynamic values to be developed through group dialogues as opposed to static, already-formed values waiting to be elicited. (shrink)

Nicole Hassoun’s book Global Health Impact: Extending Access to Essential Medicines has three parts. Part 1 is about the right to health, Part 2 offers a concrete proposal for how to promote the ability of people in the developing world to live minimally good lives and Part 3 is concerned with consumer responsibility as it relates to global health. I argue that there is a philosophical tension between the respective projects of Parts 1 and 2. The project of Part 1 (...) reflects a sufficientarian ideal, namely ensuring that each person in our global community has the ability to live a minimally good life. But, the concrete proposal offered in Part 2 reflects a different ideal, namely maximizing global health benefit. While these two ideals may often converge on a set of feasible health outcomes that we should aim to bring about, they can also diverge. The extent to which they diverge depends on our specification of the minimally good life. It is therefore crucial that we have a criterion for distinguishing lives that are at least minimally good from those that are not. Unfortunately, Hassoun’s proposed criterion is problematic in that no life satisfies it. (shrink)

Hawe et al. raise concerns about Human Research Ethics Committees (HRECs) taking a risk-averse and litigation-sensitive approach to ethical review of research proposals. HRECs are tasked with reviewing proposals for compliance with the National Statement on Ethical Conduct in Human Research for the purpose of promoting the welfare of participants. While these guidelines intentionally include a significant degree of discretion in HREC decision making, there is also evidence that HRECs sometimes request changes that go beyond the guidance provided by the (...) National Statement. When HRECs request changes outside their remit, inconsistencies between individual HRECs become more common, contributing to delays in ethical review and reducing the quality of HREC decision making. Improvements to the HREC regulatory system are needed to promote transparency and accountability. (shrink)

This book provides a detailed ethnography of the lives of those with HIV, mostly women, in the Tari region of Papua New Guinea. The author, Holly Wardlow, is Professor of Anthropology at the University of Toronto, with extensive experience in Papua New Guinea and an academic focus on medical anthropology and intimate relationships. Her research for Fencing in AIDS: Gender, Vulnerability and Care in Papua New Guinea takes place over most of a decade: starting in 2004 and ending in 2013. (...) This involved two studies. The first (2004–2006), on the risk of married women contracting HIV, for which Wardlow conducted semi-structured interviews with women and trained male field assistants to interview men. The second study (2010–2013) was on the lives of HIV-positive people in treatment, which also focussed on semi-structured interviews conducted at clinic sites and concentrated on women.This is not straightforwardly a book about public health ethics. However, the central metaphor after which the book is titled—that of ‘fencing in’—is a moral norm in Tari that one’s behaviour ought to be morally constrained for people to flourish (Wardlow, 2020: 2). Ethics is also the background for much of the narrative; those who are HIV positive are often treated as ethically dubious and must prove their moral respectability. Standard ethical theory becomes more explicit in chapter 6, when Wardlow uses moral theory to interpret her research findings, and via an iterative process develops the theory further. Methodologically, this is also a feminist text, given its emphasis on women and gendered vulnerabilities to HIV infection. (shrink)

How should we measure medicines’ global health impact to set targets, monitor performance and improve health around the world? Can such a metric provide a philosophically well-grounded basis for an ethical consumption campaign that will create incentives for pharmaceutical companies and other agents to expand (equitable) access to essential medicines? And if such metrics exist, how should we think about our individual obligations to support ethical consumption campaigns on this basis? This paper reflects on these questions in light of Tim (...) Campbell’s, Yukiko Asada’s, and Andreas Albertsen’s worries about the answers I provide in Global Health Impact: Extending Access on Essential Medicines. I explain how reflecting on treatments consequences for individuals’ ability to live minimally well supports the creation of the Global Health Impact (GHI) index (https://global-health-impact.org/). I also consider how the index might be modified to better support efforts to promote everyone’s human rights. Finally, I argue that individuals should often promote positive change through GHI and other ethical consumption campaigns. (shrink)

Lack of supportive workplaces may be depriving babies and mothers of the health advantages of breastfeeding. This citizen science pilot project set out to engage women in photographing and sharing information on the available facilities for breastfeeding and expressing and storing breastmilk in Australian workplaces. While some useful insights were gained, the project failed in the sense that 234 people ‘liked’ the project Facebook page set up to recruit participants, but only nine photographs were submitted. The heaviest loss of participation (...) occurred after the ethics committee requirements were explained, in particular, the requirement for employer consent to take a photograph, or alternatively, for a participant to agree to bear the risk of taking a photo without permission. The ethics committee also made stipulations about the formality of language to be used. Thus, the project’s potential role as an enabler for health action was neutered. We argue that the ethics requirements worked contrary to our purpose and possibly acted to reinforce the powerlessness some women experience at work. (shrink)

Why should we care about global health? What obligations do we have to improve global health? How can we work towards establishing a health industry that is better equipped to deal with the most significant global health challenges? In her impressive and ambitious book, Global Health Impact: Extending Access to Essential Medicine (Hassoun, 2020), Nicole Hassoun attempts to answer these questions, by drawing on contemporary research in political philosophy, global justice, health economics and business ethics. In this symposium, Timothy Campbell, (...) Yukiko Asada and Andreas Albertsen explore three dimensions of Hassoun’s proposal: the relation between measuring global health impact and conceptions of the minimally good life, different metrics used to measure the global health burden and democratic consumption and social justice. In a response paper, Hassoun responds to the critical remarks.In her book, Hassoun presents a theoretical framework that explains why we ought to care about global health, develops a way of measuring the global health impact of health technologies and argues that individuals should be guided by this in their consumption. The book presents an ambitious proposal for how one in a very practical way can use the measuring tool in order to promote global health by labeling and certifying different market products so that consumers and investors get incentivizing information that can change their behavior in a way that promotes global health. (shrink)

The General Data Protection Regulation (GDPR) was introduced in 2018 to harmonize data privacy and security laws across the European Union (EU). It applies to any organization collecting personal data in the EU. To date, service-level consent has been used as a proportionate approach for clinical trials, which implement low-risk, routine, service-wide interventions for which individual consent is considered inappropriate. In the context of public health research, GDPR now requires that individuals have the option to choose whether their data may (...) be used for research, which presents a challenge when consent has been given by the clinical service and not by individual service users. We report here on development of a pragmatic opt-out solution to this consent paradox in the context of a partner notification intervention trial in sexual health clinics in the UK. Our approach supports the individual’s right to withhold their data from trial analysis while routinely offering the same care to all patients. (shrink)

Academic publications of empirical public health research often entail recommendations for moral action that address practitioners and policy makers. These recommendations are regularly based on implicit moral judgments with the underlying reasons not explicitly stated. In this paper, we elaborate on the moral relevance of such judgments and the need to explain them in order to account for academic argumentation. We argue for an explicit reporting of bridge principles to increase the transparency of the reporting of public health research. The (...) reporting of bridge principles can inform readers, support them in understanding the relationship between empirical and normative claims in a specific paper, and may pave new ways for the rigorous reporting of empirical research that has moral implications. Furthermore, it can be used to classify studies to systematically address the justification for their argumentation. (shrink)

Reflecting on Smith (2021) in this issue, this commentary extends our consideration of issues in carceral health and questions the dehumanizing language we sometimes use—including in public health and public health ethics—to talk about persons held in incarceration. Even the language we use for the carceral system itself (such as ‘criminal justice system’) is fraught: it casts a laudatory light on the system and papers over its role in compounding racial health inequities and in sustaining colonialism. A host of issues (...) call out for ethical analysis, using lenses that can encompass the tensions and contradictions experienced by people within the system who deliver healthcare and those within the system trying to access that care. Beyond access to health care (promotion, prevention, treatment and palliation), the societal commitment to dealing with social issues by depriving people of many key social determinants of health is at the heart of many of these tensions and contradictions. (shrink)

Complexity abounds in public health, yet public health ethics—as currently practiced—often struggles to accept this state-of-affairs; this results in moral debates that overemphasize the potential overreach of states in the pursuit of public health, while underemphasizing its morally troubling underreach. James Wilson’s Philosophy for Public Health and Public Policy: Beyond the Neglectful State (2021) represents a culmination of over a decade of his work where he tries addressing directly the challenge of complexity of reasoning about values in applied political philosophy. (...) The result is an important, well-argued, and well-written book that should be read by those who are both interested in the methods of public health ethics and how complexity-informed public health ethics can help shape policy debates.The thesis of the book is as follows: much time has been spent debating whether the state is acting as a ‘nanny’ state in regard to public health policy and practice x, and when and how this amounts to a justified burden on one’s autonomy and subsequent choices. But this misses the point: we all have a right to health, which includes a right to the fruits of public health because we are autonomous persons and autonomy is valuable. We should be wary not only of a nanny state, but of a neglectful state which absolves itself of responsibility for the various determinants of health within its control and legitimate remit. In turn, philosophers keen to help governments resolve real-world public health problems—and help states discharge their positive duty to promote health—must do so with humility while helping policy makers think through the values that underpin complex social problems. (shrink)

Incarcerated offenders are categorically high-risk patients who are disproportionately more likely to suffer from chronic illnesses than members of the general population. The conditions of confinement (e.g., overcrowding, poor nutrition, risky sexual practices) furthermore make them increasingly susceptible to acquiring an infectious disease. Past research has linked preventive care, including the early detection and treatment of such diseases, with better long-term health outcomes; however, such care is not universally provided to this population. The benefits and current availability of preventive care (...) for incarcerated offenders is discussed and several questions are raised for future discussion within a global context. In particular, these questions include whether or not incarcerated offenders should receive preventive care, the underlying reason for such provision, who should advocate for and for be responsible for their access to preventive care, and the mechanisms through which access could be attained. (shrink)

The General Data Protection Regulation imposes, at European level, a need to seek express or explicit consent for the processing of health data. In the framework of biomedical research, some favor the use of express ‘broad’ consent, whereas other maintain, or wish to maintain the use of presumed or implicit consent, often referred to as ‘non-opposition’ in conditions in which such consent is still authorized. In our view, broad consent and presumed consent are likely to prove to be easy solutions (...) in the short term but much less relevant in the long term, for both hospital and patients, if the bioethical objective remains the improvement of patient quality of life and/or survival, regardless of the disease considered. Dynamic consent could be the best way to achieve this objective because only this type of consent could improve hospital transparency and increase patient confidence by allaying certain fears. (shrink)

Conservative assumptions in medical ethics risk immense harms during a pandemic. Public health institutions and public discourse alike have repeatedly privileged inaction over aggressive medical interventions to address the pandemic, perversely increasing population-wide risks while claiming to be guided by ‘caution’. This puzzling disconnect between rhetoric and reality is suggestive of an underlying philosophical confusion. In this paper, I argue that we have been misled by status quo bias—exaggerating the moral significance of the risks inherent in medical interventions, while systematically (...) neglecting the risks inherent in the status quo prospect of an out-of-control pandemic. By coming to appreciate the possibility and significance of status quo risk, we will be better prepared to respond appropriately when the next pandemic strikes. (shrink)

In the recent literature across philosophy, medicine and public health policy, many influential arguments have been put forward to support the use of randomization procedures to allocate scarce life-saving resources. In this paper, I provide a systematic categorization and a critical evaluation of these arguments. I shall argue that those arguments justify using RAND to allocate SLSR in fewer cases than their proponents maintain and that the relevant decision-makers should typically allocate SLSR directly to the individuals with the strongest claims (...) to these resources rather than use RAND to allocate such resources. (shrink)

This paper proposes that public health is the sort of institution that has a role in producing structures of virtue in society. This proposal builds upon work that describes how virtues are structured by the practices of institutions, at the collective or whole-of-society level. This work seeks to fill a gap in public health ethics when it comes to virtues. Mainstay moral theories tend to incorporate some role for virtues, but within public health ethics this role has not been fully (...) articulated. Two recent papers have proposed ways in which the virtues might be incorporated: working from a structural account, Rozier suggests that public health could work to instil virtues, like temperance, in the public in order to achieve its health-related goals; Nihlén Fahlquist suggests that compassion is among three virtues that practitioners of public health should cultivate in order to do their work well. In the end, both accounts recommend incorporating virtues at the level of individuals, among the public and among practitioners. I propose a third kind of role for virtue in public health that focuses on structures. Public health activities take place at the population level, and a public health virtue ethics must also be suitably population-focussed. (shrink)

In this short piece, I attempt to respond to some of the challenges raised by Jessica Nihlén Fahlquist and Karen Meagher in their commentaries on my paper, ‘Public Health Virtue Ethics’. While these authors have made many insightful and challenging remarks, I mostly focus on two questions here: first, about the nature of collectives as moral agents, in response to Nihlén Fahlquist, and second, about the concept of a collective-level virtue, in response to Meagher.

The issue of COVID-19 vaccine allocation is still highly controversial on the international as well as on the national level, and policy-makers worldwide struggle in striking a fair balance between different ethical principles of vaccine allocation, in particular maximum benefit, reciprocity, social justice and equal respect. Any political decision that implements these principles comes at a cost in terms of loss of lives and of loss of life years that could potentially have been prevented by a different vaccination strategy. This (...) article illustrates these trade-offs using quantitative analysis and shows how this approach can contribute to providing a rational and transparent grounding of political decisions on COVID-19 vaccine allocation. (shrink)

MacKay’s Public Health Virtue Ethics offers a distinctive approach to public health ethics, with social structures at the forefront. MacKay’s helpful overview of the recent literature considers three distinct referents for ascribing virtues in public health ethics: (i) individuals, such as public health practitioners, (ii) social structures, such as public health institutions and policies and (iii) the communities affected by public health policy. While MacKay is interested in virtuous structures, I am interested in the structure of virtue as a precursor (...) to this approach. In this commentary, I seek to unpack the structure of virtue itself, to delineate what various accounts of public health virtues offer, including MacKay’s new account. For such clarity, I turn to David Pears’ neo-Aristotelian essay on moral courage, in which he distinguishes external goals, internal goals and countergoals. Additional virtue vocabulary advances discussion of how the moral psychology of virtue traditions can be best adapted to public health professions, policy and practice. (shrink)

Public reason demands that policies are justified to all reasonable citizens. Public health aims at protecting or improving aggregated health outcomes. Since health is not an uncontroversial value, an insurmountable chasm between public reason and public health seems to preclude any viable synthesis between the two outlooks. For any given public health policy, some reasonable citizen seems to have a reason to support ‘no policy’ over ‘some policy’, meaning that the policy cannot be justified to all. The paper first spells (...) out what exactly this conflict is about. Then, using smoking as a case, the paper outlines a model of reconciliation between public reason and public health that should give us some optimism if we want to have public health policies that are compatible with treating citizens as free and equal in the public reason sense. (shrink)

Public health ethics is commonly analyzed within a consequentialist or rights-based perspective, but recent approaches explore public health from a virtue ethical perspective. Rozier focuses on the virtues of individual members of the public and I discuss public health professionals. MacKay emphasizes the role of the collective level, the practice and social structure of public health. The structure can be important in two ways. First, it potentially affects the cultivation of the virtues of individuals. Second, the structure itself could have (...) virtues. MacKay defends the latter notion and argues that structures become objective reality that is non-reducible to individuals. She implicitly describes public health as an actor, as having hopes and aspirations. MacKay’s account is an interesting contribution to the field. I agree with that the social structure is important but argue that it is primarily important in relation to the cultivation of individual virtues. Public health is not an agent and if it is described as such, it needs a supporting argument concerning moral group agency. I argue that there are no collectives without individuals. Future studies should focus on the links between the individual and social levels and discuss which virtues are the most important. (shrink)

In several countries, governments have implemented so-called ‘COVID passport’ schemes, which restrict access to venues such as bars or sports events to those who are vaccinated against COVID-19 and/or exempt vaccinated individuals from public health measures such as curfews or quarantine requirements. These schemes have been the subject of a heated debate. Concerns about inequality have played an important role in the opposition to such schemes. This article highlights that determining how COVID passports affect equality requires a much more nuanced (...) analysis than is typically assumed. I identify a range of broadly egalitarian considerations that could be affected by the introduction of COVID passport schemes. While these schemes could undermine certain aspects of equality, I argue that they could also be used to promote equality. The magnitude and severity of these different effects, both promoting and undermining equality, depend on how precisely these schemes are framed and the local context in which they are implemented. (shrink)

This article will focus on the ethical issues of vaccine mandates and stake claim to the relatively extreme position that outright requirements for people to receive the vaccine are ethically correct at both the governmental and institutional levels. One novel strategy employed here will be to argue that deontological considerations pertaining to consent rights cut as much in favor of mandating vaccines as against them. The presumption seems to be that arguments from consent speak semi-definitively against forcing people to inject (...) something into their bodies, and so any argument in favor of mandates must produce different and overriding logical and ethical considerations. Our central claim will be that the same logic that might seem to prohibit vaccine mandates as violations of consent actually supports such mandates when viewed from the perspective of the potential bystander who might otherwise be exposed to COVID-19. (shrink)

With evidence of vaccine hesitancy in several jurisdictions, the option of making COVID-19 vaccination mandatory requires consideration. In this paper I argue that it would be ethical to make the COVID-19 vaccination mandatory for older people who are at highest risk of severe disease, but if this were to occur, and while there is limited knowledge of the disease and vaccines, there are not likely to be sufficient grounds to mandate vaccination for those at lower risk. Mandating vaccination for those (...) at high risk of severe disease is justified on the basis of the harm principle, as there is evidence that this would remove the grave public health threat of COVID-19. The risk–benefit profile of vaccination is also more clearly in the interests of those at highest risk, so mandatory vaccination entails a less severe cost to them. Therefore, a selective mandate would create fairness in the distribution of risks. The level of coercion imposed by a mandate would need to be proportionate, and it is likely that multiple approaches will be needed to increase vaccine uptake. However, a selective mandate for COVID-19 vaccines is likely to be an ethical choice and should be considered by policy-makers. (shrink)