This article offers some general criticisms of the idea that any political theory can legitimate public health interventions, and then some particular criticisms of Civic Republicanism as a political theory for public health. Civic Republicanism, I argue, legitimizes liberty-infringing public health interventions by demanding high levels of civic engagement in framing and reviewing them; to demand such engagement in pursuit of such a baseline value as health will leave insufficient civic energy for the pursuit of higher values.
On the fourth day of his presidency, Donald Trump reinstated and greatly expanded the “Mexico City policy,” which imposes antiabortion restrictions on U.S. foreign health aid. In general, the policy has prohibited U.S. funding of any family-planning groups that use even non-U.S. funds to perform abortions; prohibited aid recipients from lobbying for liberalization of abortion laws; prohibited nongovernment organizations from creating educational materials on abortion as a family-planning method; and prohibited health workers from referring patients for legal abortions in any (...) cases other than rape, incest, or to save the life of the mother. The policy's prohibition on giving aid to any organization that performs abortions is aimed at limiting alleged indirect funding of abortions. The argument is that if U.S. money is used to fund nonabortion programs of an abortion-providing NGO, then the NGO can simply shift the money thus saved into its abortion budget. Outside the context of abortion, we do not reason this way. And the policy's remaining three prohibitions are deeply troubling. (shrink)
The United Kingdom's coalition government has just begun the most sweeping overhaul of the National Health Service since its inception.1 Under the reforms, 80 percent of the NHS budget will be handed over to about five hundred local consortia of primary care physicians, who will be empowered to make medical spending and allocation decisions for their patients. The 152 existing Primary Care Trusts (PCTs), which purchase hospital and community care for patients and oversee primary care physicians in their regions, will (...) close their doors, leaving local doctors with the power to decide which interventions are appropriate, and which too expensive.2 Hospitals and community service providers will have greater freedom .. (shrink)
These are hard days for globalism. A major candidate for the United States presidency ran on an anti-immigration, anti-free-trade platform and denounced such venerable international institutions as the North Atlantic Treaty Organization and the United Nations. The European Union is under threat after the vote for Brexit; the Euro is under strain. China is denouncing and ignoring the result of an international arbitration over its claims to the South China Sea. Nationalist, xenophobic political parties are in the ascendency around the (...) world, buoyed by the fears and pains of populations for whom global trade has been no boon and to whom waves of new immigrants seem threatening both economically and socially. So it is both strange and uplifting, in this atmosphere, to encounter the ambitious and enthusiastic globalism of Lawrence Gostin's important, field-founding work, Global Health Law. Equal parts encyclopedia and manifesto, the book seeks both to provide exhaustive and up-to-date descriptions of the already-substantial body of international health law and of its implementing institutions and to chart Gostin's vision for their vigorous expansion. And that vision is nothing if not expansive. (shrink)
In the United States, while it is legal for physicians to prescribe drugs for “off-label” indications (uses for which the drugs do not have Food and Drug Administration approval), it is largely—though not entirely—illegal for drug manufacturers to promote off-label uses of their drugs to physicians. In recent months, the rules against off-label marketing have been rigorously enforced: in October, Allergan reached a $375 million settlement over off-label promotion of Botox; in September, Novartis settled an off-label marketing dispute for $422.5 (...) million, and Forest Laboratories settled one for $313 million. These were only the latest in a series of criminal and civil settlements on off-label promotion, the most .. (shrink)
In bioethics as in other areas of health policy, historical institutional factors can shape policy independently of interests or public opinion. This article finds policy divergence among countries with similar national moral views of stem cell research, and explains that divergence as the product of path-dependency.
