Machine generated contents note: Preface; Introduction AngusDawson; Part I. Concepts: 1. Resetting the parameters: public health as the foundation for public health ethics AngusDawson; 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 (...) class='Hi'>AngusDawson; 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)
A number of ethical frameworks have been proposed to support decision-making in public health and the evaluation of public health policy and practice. This is encouraging, since ethical considerations are of paramount importance in health policy. However, these frameworks have various deficiencies, in part because they incorporate substantial ethical positions. In this article, we discuss and criticise a framework developed by James Childress and Ruth Bernheim, which we consider to be the state of the art in the field. Their (...) framework distinguishes aims, such as the promotion of public health, from constraints on the pursuit of those aims, such as the requirement to avoid limitations to liberty, or the requirement to be impartial. We show how this structure creates both theoretical and practical problems. We then go on to present and defend a more practical framework, one that is neutral in avoiding precommitment to particular values and how they ought to be weighted. We believe ethics is at the very heart of such weightings and our framework is developed to reflect this belief. It is therefore both pluralist and value-based. We compare our new framework to Childress and Bernheim’s and outline its advantages. It is justified by its impetus to consider a wide range of alternatives and its tendency to direct decisions towards the best alternatives, as well as by the information provided by the ranking of alternatives and transparent explication of the judgements that motivate this ranking. The new framework presented should be useful to decision-makers in public health, as well as being a means to stimulate further reflection on the role of ethics in public health. (shrink)
Concerned with criticizing representational theories of knowledge by developing alternative concepts of knowing and communicating, Ian Angus and Lenore Langsdorf bring together eight essays that are united by a common theme: the convergence of philosophy and rhetoric. In the first chapter, Angus and Langsdorf illustrate the centrality of critical reasoning to the nature of questioning itself, arguing that human inquiry has entered a "new situation" where "the convictions and orientations that have traditionally marked the separation of rhetoric and (...) philosophy—the concern for truth and the focus on persuasion—have begun to converge on a new space that can be defined through the central term _discourse._"_ _In these essays, this convergence of rhetoric and philosophy is addressed as it presents itself to a variety of interests that transcend the traditional boundaries of these fields. The two editors, Raymie E. McKerrow, Michael J. Hyde and Craig R. Smith, James W. Hikins and Kenneth S. Zagacki, Calvin O. Schrag and David James Miller, and Richard L. Lanigan map this new space, recognizing that such mapping "simultaneously _constitutes _the territory mapped.". (shrink)
This new edition of William James’s 1909 classic, A Pluralistic Universe reproduces the original text, only modernizing the spelling. The books has been annotated throughout to clarify James’s points of reference and discussion. There is a new, fuller index, a brief chronology of James’s life, and a new bibliography—chiefly based on James’s own references. The editor, H.G. Callaway, has included a new Introduction which elucidates the legacy of Jamesian pluralism to survey some related questions of contemporary (...) American society. -/- A Pluralistic Universe was the last major book James published during his life time. It is a substantial philosophical work, devoted to a thorough-going criticism of Hegelian monism and Absolutism—and the exploration of philosophical and social-theological alternatives. Our world of some one hundred years on is much the better for James’s contributions; and understanding James’s pluralism deeply contributes even now to America’s self-understanding. At present, we are more certain that American is, and is best, a pluralistic society, than we are of what particular forms our pluralism should take. Keeping an eye out for social interpretations of Jamesian pluralism, this new philosophical reading casts light on our twenty-first century alternatives by reference to prior American experience and developments. -/- . (shrink)
William James had the courage to experience the collision of European and American ways of thinking head on, and to emerge from it with a new philosophy - one displaying a remarkable vitality for dealing with the transformative issues at the core of the human condition. This easy to read introduction to his life and work explains why James' work is overwhelmingly valuable to us today in getting to grips with the spiritual dimension of human experience.
In this paper I argue that bioethics is in crisis and that it will not have a future unless it begins to embrace a more Socratic approach to its leading assumptions. The absence of a critical and sceptical spirit has resulted in little more than a dominant ideology. I focus on three key issues. First, that too often bioethics collapses into medical ethics. Second, that medical ethics itself is beset by a lack of self-reflection that I characterize here as a (...) commitment to three dogmas. Third, I offer a more positive perspective by suggesting how bioethics may benefit from looking towards public health ethics as a new source of inspiration and direction. (shrink)
In order to improve our understanding of the components that reflect functionally important processes during reward anticipation and consumption, we used principle components analyses (PCA) to separate and quantify averaged ERP data obtained from each stage of a modified monetary incentive delay (MID) task. Although a small number of recent ERP studies have reported that reward and loss cues potentiate ERPs during anticipation, action preparation, and consummatory stages of reward processing, these findings are inconsistent due to temporal and spatial overlap (...) between the relevant electrophysiological components. Our results show three components following cue presentation are sensitive to incentive cues (N1, P3a, P3b). In contrast to previous research, reward‐related enhancement occurred only in the P3b, with earlier components more sensitive to break‐even and loss cues. During feedback anticipation, we observed a lateralized centroparietal negativity that was sensitive to response hand but not cue type. We also show that use of PCA on ERPs reflecting reward consumption successfully separates the reward positivity from the independently modulated feedback‐P3. Last, we observe for the first time a new reward consumption component: a late negativity distributed over the left frontal pole. This component appears to be sensitive to response hand, especially in the context of monetary gain. These results illustrate that the time course and sensitivities of electrophysiological activity that follows incentive cues do not follow a simple heuristic in which reward incentive cues produce enhanced activity at all stages and substages. (shrink)
In these twelve papers notable ethicists use the resources of ethical theory to illuminate important theoretical and practical topics, including the nature of public health, notions of community, population bioethics, the legitimate role of law, the use of cost-effectiveness as a methodology, vaccinations, and the nature of infectious disease.
How important is the concept of solidarity in our society's calculus of consent as regards the legitimacy and ethical and political support for public health, health policy, and health services? By the term “calculus of consent,” we refer to the answer that people give to rationalize and justify their obedience to laws, rules, and policies that benefit others. The calculus of consent answers questions such as, Why should I care? Why should I help? Why should I contribute to the public (...) provision of others? Consent here does not have to be a deliberate, explicit act of informed agreement. And a calculus does not have to be a quantifiable, quasimathematical operation; more often, such a calculus takes narrative form in stories that a society tells about itself and that individuals tell about their place in it. One vital function of bioethics is to inform and shape those stories. Bioethics has the potential to offer society a keener insight into and perception of what is ethically at stake in controversies concerning health, science, and society. This insight is what we shall refer to as a “moral imagination,” by which we do not mean make-believe or fantasy but, rather, the capacity to take a critical distance from the given, to think reality otherwise. The moral imagination enables one to see connections between factors at work in history, in large social and communal structures, and in the shape of one's own life, thoughts, and feelings. Here we are especially concerned with the contribution that the concept of solidarity can make to the moral imagination of bioethics. We contend that solidarity must become more widely active and explicit in bioethics analysis and argumentation as it endeavors to shape reasons for obeying norms and rules of common benefit in an open, diverse society. (shrink)
The Médecins Sans Frontières ethics review board has been solicited in an unprecedented way to provide advice and review research protocols in an ‘emergency’ mode during the recent Ebola epidemic. Twenty-seven Ebola-related study protocols were reviewed between March 2014 and August 2015, ranging from epidemiological research, to behavioural research, infectivity studies and clinical trials with investigational products at early development stages. This article examines the MSF ERB’s experience addressing issues related to both the process of review and substantive ethical issues (...) in this context. These topics include lack of policies regarding blood sample collection and use, and engaging communities regarding their storage and future use; exclusion of pregnant women from clinical and vaccine trials; and the difficulty of implementing timely and high-quality qualitative/anthropological research to consider potential upfront harms. Having noticed different standards across ethics committees, we propose that when multiple ethics reviews of clinical and vaccine trials are carried out during a public health emergency they should be accompanied by transparent communication between the ECs involved. The MSF ERB experience should trigger a broader discussion on the ‘optimal’ ethics review in an emergency outbreak and what enduring structural changes are needed to improve the ethics review process. (shrink)
It has been acknowledged on numerous occasions that personal religiousness is a potential source of ethical norms, and consequently, an influence in ethical evaluations. An extensive literature review provides little in the way of empirical investigation of this recognized affect. This investigation conceptualizes religiousness as a motivation for ethical action, and discovers significant differences in ethical judgements among respondents categorized by personal religious motivation. Suggestions as to the source of these differences, and the implications which they offer to managers are (...) discussed and supported from the literature. (shrink)
This paper explores the notion of reciprocity in the context of active pulmonary and laryngeal tuberculosis treatment and related control policies and practices. We seek to do three things: First, we sketch the background to contemporary global TB care and suggest that poverty is a key feature when considering the treatment of TB patients. We use two examples from TB care to explore the role of reciprocity: isolation and the use of novel TB drugs. Second, we explore alternative means of (...) justifying the use of reciprocity through appeal to different moral and political theoretical traditions. We suggest that each theory can be used to provide reasons to take reciprocity seriously as an independent moral concept, despite any other differences. Third, we explore general meanings and uses of the concept of reciprocity, with the primary intention of demonstrating that it cannot be simply reduced to other more frequently invoked moral concepts such as beneficence or justice. We argue that reciprocity can function as a mid-level principle in public health, and generally, captures a core social obligation arising once an individual or group is burdened as a result of acting for the benefit of others. We conclude that while more needs to be explored in relation to the theoretical justification and application of reciprocity, sufficient arguments can be made for it to be taken more seriously as a key principle within public health ethics and bioethics more generally. (shrink)
Médecins Sans Frontières is one of the world’s leading humanitarian medical organizations. The increased emphasis in MSF on research led to the creation of an ethics review board in 2001. The ERB has encouraged innovation in the review of proposals and the interaction between the ERB and the organization. This has led to some of the advances in ethics governance described in this paper.
The generation of evidence is integral to the work of public health and health service providers. Traditionally, ethics has been addressed differently in research projects, compared with other forms of evidence generation, such as quality improvement, program evaluation, and surveillance, with review of non-research activities falling outside the purview of the research ethics board. However, the boundaries between research and these other evaluative activities are not distinct. Efforts to delineate a boundary – whether on grounds of primary purpose, temporality, underlying (...) legal authority, departure from usual practice, or direct benefits to participants – have been unsatisfactory. (shrink)
ABSTRACTThere are many different ethical arguments that might be advanced for and against childhood vaccinations. In this paper I explore one particular argument that focuses on the idea that such vaccinations are justifiable because they are held to be in the best interests of a particular child. Two issues arise from this idea. The first issue is how best interests are to be determined in this case. The second issue is what follows from this to justify potential interventions within the (...) family in relation to such vaccinations. I argue that best interests must be characterised objectively in such situations and that this means that, in at least some cases, parental decision‐making about vaccinating their children may be overridden. (shrink)
Hilary Putnam's Twin Earth thought experiment has come to have an enormous impact on contemporary philosophical thought. But while most of the discussion has taken place within the context of the philosophy of mind and language, Terence Horgan and Mark Timmons (H8cT) have defended the intriguing suggestion that a variation on the original thought experiment has important consequences for ethics.' In a series of papers, they' ve developed the idea of a Moral Twin Earth and have argued that its significance (...) is that it has the resources to undermine naturalistic versions of moral realism.' H8t T don't hold back in their assessment. "Moral Twin.. (shrink)
In this paper I provide a critique of a set of assumptions relating to agency, choice and the legitimacy of actions impacting health that can be seen in some approaches to health promotion. After a brief discussion about the definition of health promotion, I outline two contrasting approaches to this area of health care practice. The first is focused on the provision of information and the second is concerned with seeking to change people’s preferences in a particular way. It has (...) been argued by a number of critics of health promotion that only the first approach is ethical, as it is for individuals to make their own lifestyle choices and adopt their own conception of the good life. I argue against this ‘information’ approach to health promotion on two grounds. First, I suggest that given the aims of health promotion, the provision of information is, as a matter of fact, of limited effectiveness in achieving these aims. Second, I argue that we have good reasons to question the appropriateness of respecting many of the preferences that individuals happen to have, given the origins and quality of such preferences. I then go on to argue, that by contrast we have good reasons to focus on changing at least some of the preferences that people have related to their lifestyle choices. This involves a commitment to both paternalism and a defence of a certain conception of the good life, but both can be defended. I use the example of potential responses to the growing problem of obesity to illustrate my argument, arguing that only policy that, at least sometimes, aims at preference change will be both effective and ethical. (shrink)
NThere are many problems with Levi and Green’s (2010) suggestion that a computer-based decision aid will overcome the major objections to advance directives (ADs). We focus on just two here. First, we argue that the key assumption underlying Levi and Green’s paper, that autonomy always ought to take priority over other values, is false. Second, we argue that the paper misses the point of the most telling objections to the use of ADs: they lack the relevant moral authority to determine (...) treatments. It is not that they are merely subject to a set of contingent problems related to capturing the wishes of individuals or being open to misinterpretation by others.We conclude that the plug should be pulled on Levi and Green’s computer-based proposal. (shrink)
Widespread obesity poses a serious challenge to health outcomes in the developed world and is a growing problem in the developing world. There has been a raft of proposals to combat the challenge of obesity, including restrictions on the nature of food advertising, the content of prepared meals, and the size of sodas; taxes on saturated fat and on calories; and mandated “healthy-options” on restaurant menus. Many of these interventions seem to have a greater impact on rates of obesity than (...) does simply providing information about health risks and healthier lifestyles. The more interventionist policy options have, however, been implemented only slowly, in large part because of criticisms that they are unjustified infringements on the liberty of consumers. Food industry groups, free-market think tanks, and the popular press regard measures that incentivize or penalize particular food and lifestyle choices as unjustifiable state regulation of purely self-regarding behavior. To counteract the liberty-oriented position, those who favor a more interventionist role for the state have recently argued for labeling obesity as a public health emergency. By labeling obesity as a public health emergency, policy-makers could override concerns about individual liberty in order to pursue more interventionist policies designed to guide consumer choices toward healthier lifestyles. In this paper, we argue that, contrary to initial appearances, obesity possesses some of the morally relevant features of public health emergencies, though we do not argue that it actually constitutes one. (shrink)
The World Health Organisation's programme for the eradication of poliomyelitis as currently practised in India raises many ethical issues. In this paper we concentrate on just two. The first is the balance to be struck between the risks and benefits generated by the eradication programme itself. The issue of risks and benefits arises in relation to the choice between two different vaccine types available for polio programmes: oral polio vaccine (OPV) and inactivated polio vaccine (IPV). OPV is the vaccine currently (...) used in the eradication campaign in India. We argue that given the current risks/benefits profile of this vaccine, there is an urgent need to review the programme and take remedial action to address existing problems (at least in India). The second issue we discuss is the fact that there is little effort to gain the informed consent of the parents of vaccinated children, as they are not currently told about the potential limitations of OPV or the possibility of vaccine-induced harm. We suggest that such a policy might be justifiable, given the importance of polio eradication, but only if there is a system of compensation for vaccine-induced harm as part of the eradication programme itself. There is a real danger that if these issues are not addressed then public trust in the eradication programme and vaccination programmes as a whole will be lost. (shrink)
This paper argues that qualitative research is both useful and necessary, as it provides an essential means of gaining a richer understanding of patients' perceptions, social processes and meanings. In their paper in this edition of Clinical Ethics, Hallowell and Lawton raise many issues relating to the way that qualitative research is treated by RECs in the UK. In this paper I discuss just three key topics stimulated by their paper: the way that methodology relates to ethics, the experience and (...) character of the researcher, and the normative/descriptive distinction. I strongly support Hallowell and Lawton's appeal for greater communication between qualitative researchers and RECs. In other respects, I would argue that they do not go far enough. The recent review of research ethics structures and the review process provides an opportunity to move away from the present 'one size fits all' approach to ethical review. I would argue that this change could only benefit qualitative research and researchers. (shrink)
This article briefly reviews the various papers contained in this volume. They were originally presented at a research workshop held at Keele University in the UK in February 2003. It is suggested that the different papers raise a series of related legal, social and ethical issues and can be collectively seen to demonstrate the fact that policy formation in relation to reproductive matters is highly contested. It is concluded that ethical policy formation in this area needs to be based on (...) actual evidence of harm rather than assumed harm and that this therefore entails more empirical research into reproductive matters. (shrink)
This paper is concerned with how public health policy makers should respond to the publicâs perception of risks. I suggest that we can think of this issue in terms of two different models of responding to the publicâs view of such perceived risks. The first model I will call the public perception view (PP view) and the second the public good view (PG view). The PP view suggests that the publicâs perception of any risks is so important that public health (...) policies should be formulated in direct response to knowledge about them. I will consider two possible ethical arguments that might be offered in support of such a view: the first argument is an autonomy argument and the second a consequences argument. I suggest there are serious problems with both arguments. I then outline an alternative model of public health policy formation that I call the public good or PG model. This model focuses on drawing distinctions between the clinical and the public health context, and argues that most of public health policy is primarily concerned with the creation and maintenance of various public goods. This latter fact means that the PP model is inappropriate for public health policy formation. (shrink)