Corporate social responsibility was historically a business-oriented idea that companies should voluntarily improve their social and environmental practices. More recently, CSR has increasingly attracted governments’ attention, and is now promoted in public policy, especially in the European Union. Conflicts can arise, however, when advanced welfare states introduce CSR into public policy. The reason for such conflict is that CSR leaves key public welfare issues to the discretion of private business. This voluntary issue assignment contrasts (...) starkly with advanced welfare states’ traditions favoring negotiated agreements and strong regulation to control corporate conduct. This article analyzes the conflicts and compatibilities arising when advanced welfare states introduce CSR, focusing on how the two traditions diverge and on how conflicts are reconciled. Empirically the study focuses on four Nordic countries—Denmark, Finland, Norway, and Sweden—widely recognized as the most advanced welfare states, and increasingly as leaders in CSR public policy. From interviews of 55 officials of government ministries, nongovernmental organizations, labor unions, and employer associations, the authors conclude that tension indeed exists between CSR public policies and advanced welfare state traditions in all four countries. Whereas CSR’s aims are compatible with Nordic institutional traditions, the means promoted in CSR is in conflict with such Nordic traditions as corporatist agreements and rights-based welfare state regulation of social and environmental issues. There is harmony of goals, but conflict in means between the four Nordic countries studied. (shrink)

Responsible public policy making in a technological society must rely on complex scientific reasoning. Given that ordinary citizens cannot directly assess such reasoning, does this call the democratic legitimacy of technical public policies in question? It does not, provided citizens can make reliable second-order assessments of the consensus of trustworthy scientific experts. I develop criteria for lay assessment of scientific testimony and demonstrate, in the case of claims about anthropogenic global warming, that applying such criteria (...) is easy for anyone of ordinary education with access to the Web. However, surveys show a gap between the scientific consensus and public opinion on global warming in the U.S. I explore some causes of this gap and argue that democratic reforms of our culture of political discourse may be able to address it. (shrink)

In this response to Jonny Anomaly’s ‘Is Obesity a Public Health Problem?’ I argue, contra the author that public health actually increases individuals’ abilities to choose actions that further their health goals, specifically in the case of obesity. The intractability of obesity as an individual medical problem combined with the health benefits of modest (5–10 per cent of body weight) weight loss suggest that public health measures helping people make small changes in eating habits improve population health. (...) I argue that such measures are available to public health via behavioral economic research and policy proposals from libertarian paternalists. I respond to author’s claim that obesity does not constitute a public health problem because: (i) it is not an epidemic and (ii) obesity reduction is not a public good. I argue that epidemic status is not required for classification as a public health problem, but that obesity does have the status of an epidemic. I also point out flaws in author’s reasoning about obesity, public health and social costs. I conclude by suggesting that public health, in partnership with stakeholders and other areas of government, is poised to help create conditions for modest weight loss and increased population health overall. (shrink)

Photo by Tingey Injury Law Firm on Unsplash ABSTRACT The coverage of healthcare costs allegedly brought about by people’s own earlier health-adverse behaviors is certainly a matter of justice. However, this raises the following questions: justice for whom? Is it right to take people’s past behaviors into account in determining their access to healthcare? If so, how do we go about taking those behaviors into account? These bioethical questions become even more complex when we consider them in the context (...) of a commitment to publicly funded, universal healthcare coverage. INTRODUCTION Healthcare coverage of lifestyle-related conditions is certainly a matter of justice. However, this raises the following justice-related question: Is it right to consider people’s past behaviors in determining their access to healthcare? If so, the methods of taking those behaviors into account must be fair and justifiable. This bioethical question becomes even more complex when we consider it in the context of a commitment to publicly funded, universal healthcare coverage. This paper takes an old, classic debate, evaluates newer approaches, and offers an argument favoring a combined approach which alters the liberal-egalitarian solution to account for social justice. ANALYSIS l. Causes of Disease If healthcare coverage were universal, irrespective of socioeconomic status and lifestyle, people would contribute to the cost of remedying the lifestyle-induced health problems of others. In the West, lifestyle-related diseases are burdensome.[1] This paper approaches this concern from a western lens that incorporates both a European tradition of “social safety nets” and an American tradition of personal freedoms. By taking such an approach, solutions to the consequences of one’s past behavior burdening others must consider an individual’s personal freedom to choose to act as he or she wishes, with the distributive social and economic equality of the many. The concept of disease caused by lifestyle and diet is proven. Many health conditions include behavioral risk factors. Multi-pack smoking increases the risk of chronic lung disease, while obesity increases the risk of type 2 diabetes. Inattention to high blood pressure, high cholesterol, and a lack of exercise leads to increased risks of coronary artery disease.[2] While poor lifestyle choices certainly influence these conditions, their causes are multifactorial, and it is difficult to say that any single string of poor choices led to their development. In a scenario where two men excessively eat fast food for 20 years, several discrete factors impact whether any of them might suffer an ischemic-embolic stroke or not. Genetics, circumstances, and activity will also contribute to outcomes. ll. Alcohol-Related End-Stage Liver Disease One paper suggests that alcohol-related end-stage liver disease (ARESLD) differs from other multifactorial disorders as alcohol alone causes the disease.[3] It justifies attributing personal responsibility to patients with ARESLD because the condition develops only after the cumulative effects of large quantities of alcohol consumed from years to decades.[4] However, the paper undermines its position by admitting that even the susceptibility to becoming an alcoholic has some degree of genetic predisposition.[5] Given the extreme scarcity of donor livers, some patients may be prioritized over others on the transplant waiting list. Since donor livers cannot be given to everyone, transplanting a liver into an alcoholic may result in death for competing candidates whose liver disease was not their fault. All else being equal, if bioethicists avoid claiming moral deficiency or judgment, those with apparently self-inflicted ARESLD will not be deprived of treatment but will have a lower priority for transplant.[6] In contrast, another position suggests that it is often difficult to define what behaviors are punishable as these are largely personal and value-laden.[7] Still, people do not support using their own resources to support the consequences of others’ poor choices, no matter how objective.[8] In democratic societies, one must take into consideration community morals and values.[9] Even if we were to punish people for their health-adverse behaviors, we could not logistically employ the vigorous and sustained efforts necessary to determine whose actions are morally weak.[10] lll. The Liberal-Egalitarian Proposal One past argument proposes a liberal-egalitarian solution to manage personal responsibility for so-called “lifestyle diseases.”[11] This Rawlsian system combines the European-style “social safety net” commitment to social and economic equality with the American liberal notion of pluralist toleration and personal freedoms. This idealized system aims to hold people responsible for their choices rather than the consequences to mitigate the downside of blaming those who might not be blameworthy. The approach avoids determining the questionable nature of luck and personal responsibility for health outcomes, fairness in the distribution of economic burden, and the intrusiveness required to practically determine who acts in a morally wrong and health-adverse way. The liberal-egalitarian model, a theory of distributive justice, has two facets: the liberal principle that people should be held accountable for their choices and the egalitarian principle that people who make the same choices should have the same outcomes.[12] This model attempts to fuse responsibility with equity by seeking to reward good behavior and tax bad behavior rather than punish the consequences of the action and navigate who deserves treatment. For instance, the hospital bedside is not the appropriate place to introduce responsibility for one’s health outcomes.[13] This appeals to the reality that, at that time, discerning the true causes of disease was not plausible and to humanity in avoiding a heartless and cruel approach. An argument in favor of the liberal-egalitarian model considers its method of implementation. This approach assumes that the healthcare system treats all individuals regardless of their choices or ability to cover costs. The liberal-egalitarian model also assumes that a certain adverse health condition is related, statistically speaking, to the consumption of a certain good and that good can be taxed. As such, it proposes to tax the consumption of that good to finance the collective burden which arises from that good’s consumption rather than require individuals to pay for their own treatment. In the example of ARESLD, the recommended solution would be taxing all alcohol. While a systematic infrastructure is not explicit, there is the implication that a per-unit tax can be imposed on alcohol so the total tax revenue would make up for the additional healthcare costs due to consumption.[14] Upholding the principle that all people who make the same choices should face the same costs, all consumers of alcohol would pay the same tax, regardless of factors such as genetic predisposition to alcoholism, lifestyle, or expected cost of treatment. Upholding the principle of individual responsibility, this model does not deny treatment to anyone, neutralizing factors outside that individual’s control by imposing the tax ex-ante. Other people are not burdened by those who consume the good. People who consume alcohol face a burden proportional to the amount consumed. This tax-based implementation is justified so long as the tax is not prohibitively high for the average consumer. Further, the model mitigates concerns over the intrusiveness of ascribing morality to health-adverse behaviors. lV. Moral and Social Arguments Against the Liberal-Egalitarian Position Arguments against the liberal-egalitarian model concerns its many assumptions. First, this model assumes that consumption of such goods is directly related to the health outcome and that these goods can be taxed.[15] Certain people genetically predisposed to alcoholism would be predisposed to consume more alcohol. The model falls short when applied to scenarios where health outcomes are not consumption-based, such as engaging in unsafe sex or abstaining from healthy lifestyle choices like exercise. Second, some might argue that the liberal-egalitarian model fails to remain neutral. Residual moral judgments tied to consumption choices introduce non-neutrality. Although taxation in free societies is determined by democratic procedures rather than by individuals in the healthcare system, moral and value-based judgments will be implicit in deciding what behaviors are taxable, such as the purchase of cigarettes. Third, the liberal-egalitarian model fails to determine whether one’s behavior is autonomous, as socio-cultural-economic factors may influence it and behavior is more a product of society, peer pressure, or income. Those also may reflect systemic inequalities. Therefore, this model, which rewards, or taxes based solely on decisions, regardless of their consequences and motivations, fails to consider that a person’s decisions may not be completely autonomous. V. Libertarian Arguments Against the Liberal-Egalitarian Model a. State Intrusiveness as Counter to the Liberal-Egalitarian Model Last, there is a libertarian worry that if the state guarantees universal healthcare coverage to all people, the state will have to become highly intrusive and investigate people’s morals.[16] At least one-third of all disease burden in North America, Europe, and the Asia-Pacific is attributable to lifestyle measures such as tobacco smoking, alcohol consumption, high cholesterol, and obesity.[17] With these various lifestyles, it is not likely to agree on what conduct to tax or condemn.[18] The fine-toothed comb required to determine whether each citizen has been engaging in these behaviors would intrude on daily life and personal freedom. Libertarians champion the argument that impractical intrusiveness would result from universal healthcare, and such a degree of intrusiveness would likely be universally unacceptable.[19] The liberal-egalitarian model mitigates the libertarian worry about state intrusiveness as it does not involve prying into one’s life and choices other than taxing goods. A liberal state should ideally be neutral to how people decide to live their lives. In all, libertarians can rest assured that the liberal-egalitarian tax-based model, through its ex-ante implementation, will require no prying state eyes. States that provide universal healthcare coverage and wish to condemn certain misconduct do not need to become overly intrusive to carry out measures to hold individuals accountable. b. Fairness Another libertarian worry regarding the guarantee of universal healthcare coverage in the context of lifestyle-driven diseases is that the public will be burdened unfairly with covering others’ ill-advised mistakes or bad luck. An ideal system to address this worry would link treatment or payment for treatment with whatever behavior caused that need.[20] The distribution of burdens should be linked to how different individuals contributed to the creation of those burdens. Applied to health policy, we should ask how the need for a certain treatment arose when determining how to distribute its cost.[21] The liberal-egalitarian model aspires to hold individuals responsible for their choices, not for the consequences of such choices. This model significantly mitigates the libertarian worry over unfair burdens for covering other people’s mistakes or social conditions, which lead to those bad outcomes, by ensuring to not burden others with any of the costs for the treatment of people who decide to engage in certain health-adverse behaviors. The aforementioned taxation-based system would only tax those who also engage in the health-adverse behavior through consumption, and that tax directly pays for the necessary collective treatment. As such, those who do not consume the good are not involved with the payment scheme, while those who do consume the good are responsible for payment in a matter proportional to the amount of the good they have consumed. Vl. Universal Coverage Taking a step back, one should consider whether these worries regarding the coverage of apparently self-inflicted health conditions in the context of universal healthcare are worthwhile issues. One perspective raises what is called the culturally imagined objection — an idea erroneously held by many that sick people, especially those who are poor and uneducated, bring these illnesses upon themselves due to poor decision-making and irresponsible risk-taking.[22] This perspective critiques the uniquely American view that, since individuals are free to choose their lifestyles, they should bear the costs of their lifestyle.[23] Taking this argument further, some (perhaps the strongly libertarian) would say that the poor health status among many individuals is the price individuals must pay for their American way of life and the liberty and freedom to live as they wish. However, people should not completely punish individuals for their health-adverse behaviors because these choices are largely pre-determined by a person’s socioeconomic influences.[24] The outcomes from these allegedly ill-advised behaviors, which largely affect poorer people, are not just poor behavior but rather a public health crisis. Perhaps the state and its people should take collective responsibility and cover the costs of treatment for those health outcomes without question, as a form of public service. Rather than worrying about accountability and taxing bad behavior or intrusiveness into personal decisions, some might argue that people need to collectively take responsibility for reducing the overarching systemic inequalities and covering the associated treatment costs as a measure of public health. Vll. Proposed Solution Given the strengths of the liberal-egalitarian model and taking into account libertarian and social justice-oriented objections, an ideal solution for the coverage of lifestyle-related health problems needs to consider the complex relationship between a person’s behaviors and their apparent health outcomes. It must consider how society as a whole passes judgment on behaviors and how to take into account that many health-adverse decisions are not truly autonomous decisions, as various genetic and socioeconomic factors influence them. An ideal solution combines the liberal-egalitarian tax-based model with the social justice concerns of universal coverage. Whatever the cost for the treatment of medical issues resulting in part or entirely from lifestyle and diet, taxes collected from spending associated with the behavior (like the purchase of alcohol, junk food, and cigarettes) ex-ante should fund 50 percent of the cost of treatment, while the universal healthcare taxation scheme should include the other 50 percent. Such a system would provide an incentive to avoid the purchases that can lead to unhealthy consumption and make healthier choices, slightly punish and discourage such purchases through taxation, yet not overly punish people whose outcomes may have more to do with socioeconomic factors and genetics. Adding public responsibility demonstrates acknowledgement that health care is in the public interest and can mitigate public health inequalities. This solution would fuse personal responsibility with the public responsibility of state-sponsored social improvement while ensuring that all people have fair access to necessary treatment, no matter their ability to pay. CONCLUSION The 50-50 system this paper proposes reflects both justice and personal responsibility in covering healthcare costs allegedly brought about by people’s own health-adverse behaviors. By allocating tax revenue from consumption that contributes or even alone causes poor health outcomes, such a system incorporates personal responsibility. By using general tax revenue for health care, such a system would meet the libertarian requirement of providing care without any moral investigation of past behaviors and the social justice consideration of providing health care to those who may have unwittingly ventured into ill-health due to systemic injustice, socioeconomics, or genetics. - [1] Cappelen, A. W. (2005). Responsibility in health care: A liberal egalitarian approach. Journal of Medical Ethics, 31(8), 476–480. https://doi.org/10.1136/jme.2004.010421 [2] Moss, A. H. (1991). Should alcoholics compete equally for liver transplantation? JAMA: The Journal of the American Medical Association, 265(10), 1295–1298. https://doi.org/10.1001/jama.1991.03460100097032 [3] Moss, p. 1295-1298. [4] Moss, p. 1296. [5] Moss, p. 1295-1298. [6] Moss, p. 1295-1298. [7] Cohen, C. IS THIS SUPPOSED TO BE COHEN AND BENJAMIN (1991). Alcoholics and liver transplantation. JAMA: The Journal of the American Medical Association, 265(10), 1299–1301. https://doi.org/10.1001/jama.1991.03460100101033 [8] Cohen, p. 1299-1301. [9] Moss, p. 1297. [10] Cohen, p. 1300. [11] Cappelen, p. 478-480. [12] Cappalen, p. 478-480. [13] Cappelen, p.479. [14] Cappelen, p. 479. [15] Cappelen, p. 479 [16] Cohen, p. 1301. [17] Cappelen, p. 478. [18] Cohen, p. 1299-1301. [19] Cohen, p. 1301. [20] Cappelen, p. 476-480. [21] Cappelen, p. 476-480. [22] Kawachi, I. (2005). Why the United States is not number one in Health. Healthy, Wealthy, and Fair, 18–33. https://doi.org/10.1093/acprof:oso/9780195170665.003.0013 [23] Kawachi, p. 18-33. [24] Kawachi, p. 18-33. (shrink)

Photo by Tingey Injury Law Firm on Unsplash ABSTRACT The coverage of healthcare costs allegedly brought about by people’s own earlier health-adverse behaviors is certainly a matter of justice. However, this raises the following questions: justice for whom? Is it right to take people’s past behaviors into account in determining their access to healthcare? If so, how do we go about taking those behaviors into account? These bioethical questions become even more complex when we consider them in the context (...) of a commitment to publicly funded, universal healthcare coverage. INTRODUCTION Healthcare coverage of lifestyle-related conditions is certainly a matter of justice. However, this raises the following justice-related question: Is it right to consider people’s past behaviors in determining their access to healthcare? If so, the methods of taking those behaviors into account must be fair and justifiable. This bioethical question becomes even more complex when we consider it in the context of a commitment to publicly funded, universal healthcare coverage. This paper takes an old, classic debate, evaluates newer approaches, and offers an argument favoring a combined approach which alters the liberal-egalitarian solution to account for social justice. ANALYSIS I. Causes of Disease If healthcare coverage were universal, irrespective of socioeconomic status and lifestyle, people would contribute to the cost of remedying the lifestyle-induced health problems of others. In the West, lifestyle-related diseases are burdensome.[i] This paper approaches this concern from a western lens that incorporates both a European tradition of “social safety nets” and an American tradition of personal freedoms. By taking such an approach, solutions to the consequences of one’s past behavior burdening others must consider an individual’s personal freedom to choose to act as he or she wishes, with the distributive social and economic equality of the many. The concept of disease caused by lifestyle and diet is proven. Many health conditions include behavioral risk factors. Multi-pack smoking increases the risk of chronic lung disease, while obesity increases the risk of type 2 diabetes. Inattention to high blood pressure, high cholesterol, and a lack of exercise leads to increased risks of coronary artery disease.[ii] While poor lifestyle choices certainly influence these conditions, their causes are multifactorial, and it is difficult to say that any single string of poor choices led to their development. In a scenario where two men excessively eat fast food for 20 years, several discrete factors impact whether any of them might suffer an ischemic-embolic stroke or not. Genetics, circumstances, and activity will also contribute to outcomes. II. Alcohol-Related End-Stage Liver Disease One paper suggests that alcohol-related end-stage liver disease (ARESLD) differs from other multifactorial disorders as alcohol alone causes the disease.[iii] It justifies attributing personal responsibility to patients with ARESLD because the condition develops only after the cumulative effects of large quantities of alcohol consumed from years to decades.[iv] However, the paper undermines its position by admitting that even the susceptibility to becoming an alcoholic has some degree of genetic predisposition.[v] Given the extreme scarcity of donor livers, some patients may be prioritized over others on the transplant waiting list. Since donor livers cannot be given to everyone, transplanting a liver into an alcoholic may result in death for competing candidates whose liver disease was not their fault. All else being equal, if bioethicists avoid claiming moral deficiency or judgment, those with apparently self-inflicted ARESLD will not be deprived of treatment but will have a lower priority for transplant.[vi] In contrast, another position suggests that it is often difficult to define what behaviors are punishable as these are largely personal and value-laden.[vii] Still, people do not support using their own resources to support the consequences of others’ poor choices, no matter how objective.[viii] In democratic societies, one must take into consideration community morals and values.[ix] Even if we were to punish people for their health-adverse behaviors, we could not logistically employ the vigorous and sustained efforts necessary to determine whose actions are morally weak.[x] III. The Liberal-Egalitarian Proposal One past argument proposes a liberal-egalitarian solution to manage personal responsibility for so-called “lifestyle diseases.”[xi] This Rawlsian system combines the European-style “social safety net” commitment to social and economic equality with the American liberal notion of pluralist toleration and personal freedoms. This idealized system aims to hold people responsible for their choices rather than the consequences to mitigate the downside of blaming those who might not be blameworthy. The approach avoids determining the questionable nature of luck and personal responsibility for health outcomes, fairness in the distribution of economic burden, and the intrusiveness required to practically determine who acts in a morally wrong and health-adverse way. The liberal-egalitarian model, a theory of distributive justice, has two facets: the liberal principle that people should be held accountable for their choices and the egalitarian principle that people who make the same choices should have the same outcomes.[xii] This model attempts to fuse responsibility with equity by seeking to reward good behavior and tax bad behavior rather than punish the consequences of the action and navigate who deserves treatment. For instance, the hospital bedside is not the appropriate place to introduce responsibility for one’s health outcomes.[xiii] This appeals to the reality that, at that time, discerning the true causes of disease was not plausible and to humanity in avoiding a heartless and cruel approach. An argument in favor of the liberal-egalitarian model considers its method of implementation. This approach assumes that the healthcare system treats all individuals regardless of their choices or ability to cover costs. The liberal-egalitarian model also assumes that a certain adverse health condition is related, statistically speaking, to the consumption of a certain good and that good can be taxed. As such, it proposes to tax the consumption of that good to finance the collective burden which arises from that good’s consumption rather than require individuals to pay for their own treatment. In the example of ARESLD, the recommended solution would be taxing all alcohol. While a systematic infrastructure is not explicit, there is the implication that a per-unit tax can be imposed on alcohol so the total tax revenue would make up for the additional healthcare costs due to consumption.[xiv] Upholding the principle that all people who make the same choices should face the same costs, all consumers of alcohol would pay the same tax, regardless of factors such as genetic predisposition to alcoholism, lifestyle, or expected cost of treatment. Upholding the principle of individual responsibility, this model does not deny treatment to anyone, neutralizing factors outside that individual’s control by imposing the tax ex-ante. Other people are not burdened by those who consume the good. People who consume alcohol face a burden proportional to the amount consumed. This tax-based implementation is justified so long as the tax is not prohibitively high for the average consumer. Further, the model mitigates concerns over the intrusiveness of ascribing morality to health-adverse behaviors. IV. Moral and Social Arguments Against the Liberal-Egalitarian Position Arguments against the liberal-egalitarian model concerns its many assumptions. First, this model assumes that consumption of such goods is directly related to the health outcome and that these goods can be taxed.[xv] Certain people genetically predisposed to alcoholism would be predisposed to consume more alcohol. The model falls short when applied to scenarios where health outcomes are not consumption-based, such as engaging in unsafe sex or abstaining from healthy lifestyle choices like exercise. Second, some might argue that the liberal-egalitarian model fails to remain neutral. Residual moral judgments tied to consumption choices introduce non-neutrality. Although taxation in free societies is determined by democratic procedures rather than by individuals in the healthcare system, moral and value-based judgments will be implicit in deciding what behaviors are taxable, such as the purchase of cigarettes. Third, the liberal-egalitarian model fails to determine whether one’s behavior is autonomous, as socio-cultural-economic factors may influence it and behavior is more a product of society, peer pressure, or income. Those also may reflect systemic inequalities. Therefore, this model, which rewards, or taxes based solely on decisions, regardless of their consequences and motivations, fails to consider that a person’s decisions may not be completely autonomous. V. Libertarian Arguments Against the Liberal-Egalitarian Model a. State Intrusiveness as Counter to the Liberal-Egalitarian Model Last, there is a libertarian worry that if the state guarantees universal healthcare coverage to all people, the state will have to become highly intrusive and investigate people’s morals.[xvi] At least one-third of all disease burden in North America, Europe, and the Asia-Pacific is attributable to lifestyle measures such as tobacco smoking, alcohol consumption, high cholesterol, and obesity.[xvii] With these various lifestyles, it is not likely to agree on what conduct to tax or condemn.[xviii] The fine-toothed comb required to determine whether each citizen has been engaging in these behaviors would intrude on daily life and personal freedom. Libertarians champion the argument that impractical intrusiveness would result from universal healthcare, and such a degree of intrusiveness would likely be universally unacceptable.[xix] The liberal-egalitarian model mitigates the libertarian worry about state intrusiveness as it does not involve prying into one’s life and choices other than taxing goods. A liberal state should ideally be neutral to how people decide to live their lives. In all, libertarians can rest assured that the liberal-egalitarian tax-based model, through its ex-ante implementation, will require no prying state eyes. States that provide universal healthcare coverage and wish to condemn certain misconduct do not need to become overly intrusive to carry out measures to hold individuals accountable. b. Fairness Another libertarian worry regarding the guarantee of universal healthcare coverage in the context of lifestyle-driven diseases is that the public will be burdened unfairly with covering others’ ill-advised mistakes or bad luck. An ideal system to address this worry would link treatment or payment for treatment with whatever behavior caused that need.[xx] The distribution of burdens should be linked to how different individuals contributed to the creation of those burdens. Applied to health policy, we should ask how the need for a certain treatment arose when determining how to distribute its cost.[xxi] The liberal-egalitarian model aspires to hold individuals responsible for their choices, not for the consequences of such choices. This model significantly mitigates the libertarian worry over unfair burdens for covering other people’s mistakes or social conditions, which lead to those bad outcomes, by ensuring to not burden others with any of the costs for the treatment of people who decide to engage in certain health-adverse behaviors. The aforementioned taxation-based system would only tax those who also engage in the health-adverse behavior through consumption, and that tax directly pays for the necessary collective treatment. As such, those who do not consume the good are not involved with the payment scheme, while those who do consume the good are responsible for payment in a matter proportional to the amount of the good they have consumed. VI. Universal Coverage Taking a step back, one should consider whether these worries regarding the coverage of apparently self-inflicted health conditions in the context of universal healthcare are worthwhile issues. One perspective raises what is called the culturally imagined objection — an idea erroneously held by many that sick people, especially those who are poor and uneducated, bring these illnesses upon themselves due to poor decision-making and irresponsible risk-taking.[xxii] This perspective critiques the uniquely American view that, since individuals are free to choose their lifestyles, they should bear the costs of their lifestyle.[xxiii] Taking this argument further, some (perhaps the strongly libertarian) would say that the poor health status among many individuals is the price individuals must pay for their American way of life and the liberty and freedom to live as they wish. However, people should not completely punish individuals for their health-adverse behaviors because these choices are largely pre-determined by a person’s socioeconomic influences.[xxiv] The outcomes from these allegedly ill-advised behaviors, which largely affect poorer people, are not just poor behavior but rather a public health crisis. Perhaps the state and its people should take collective responsibility and cover the costs of treatment for those health outcomes without question, as a form of public service. Rather than worrying about accountability and taxing bad behavior or intrusiveness into personal decisions, some might argue that people need to collectively take responsibility for reducing the overarching systemic inequalities and covering the associated treatment costs as a measure of public health. VII. Proposed Solution Given the strengths of the liberal-egalitarian model and taking into account libertarian and social justice-oriented objections, an ideal solution for the coverage of lifestyle-related health problems needs to consider the complex relationship between a person’s behaviors and their apparent health outcomes. It must consider how society as a whole passes judgment on behaviors and how to take into account that many health-adverse decisions are not truly autonomous decisions, as various genetic and socioeconomic factors influence them. An ideal solution combines the liberal-egalitarian tax-based model with the social justice concerns of universal coverage. Whatever the cost for the treatment of medical issues resulting in part or entirely from lifestyle and diet, taxes collected from spending associated with the behavior (like the purchase of alcohol, junk food, and cigarettes) ex-ante should fund 50 percent of the cost of treatment, while the universal healthcare taxation scheme should include the other 50 percent. Such a system would provide an incentive to avoid the purchases that can lead to unhealthy consumption and make healthier choices, slightly punish and discourage such purchases through taxation, yet not overly punish people whose outcomes may have more to do with socioeconomic factors and genetics. Adding public responsibility demonstrates acknowledgement that health care is in the public interest and can mitigate public health inequalities. This solution would fuse personal responsibility with the public responsibility of state-sponsored social improvement while ensuring that all people have fair access to necessary treatment, no matter their ability to pay. CONCLUSION The 50-50 system this paper proposes reflects both justice and personal responsibility in covering healthcare costs allegedly brought about by people’s own health-adverse behaviors. By allocating tax revenue from consumption that contributes or even alone causes poor health outcomes, such a system incorporates personal responsibility. By using general tax revenue for health care, such a system would meet the libertarian requirement of providing care without any moral investigation of past behaviors and the social justice consideration of providing health care to those who may have unwittingly ventured into ill-health due to systemic injustice, socioeconomics, or genetics. - [i] Cappelen, A. W. (2005). Responsibility in health care: A liberal egalitarian approach. Journal of Medical Ethics, 31(8), 476–480. https://doi.org/10.1136/jme.2004.010421 [ii] Moss, A. H. (1991). Should alcoholics compete equally for liver transplantation? JAMA: The Journal of the American Medical Association, 265(10), 1295–1298. https://doi.org/10.1001/jama.1991.03460100097032 [iii] Moss, p. 1295-1298. [iv] Moss, p. 1296. [v] Moss, p. 1295-1298. [vi] Moss, p. 1295-1298. [vii] Cohen, C. IS THIS SUPPOSED TO BE COHEN AND BENJAMIN (1991). Alcoholics and liver transplantation. JAMA: The Journal of the American Medical Association, 265(10), 1299–1301. https://doi.org/10.1001/jama.1991.03460100101033 [viii] Cohen, p. 1299-1301. [ix] Moss, p. 1297. [x] Cohen, p. 1300. [xi] Cappelen, p. 478-480. [xii] Cappalen, p. 478-480. [xiii] Cappelen, p.479. [xiv] Cappelen, p. 479. [xv] Cappelen, p. 479 [xvi] Cohen, p. 1301. [xvii] Cappelen, p. 478. [xviii] Cohen, p. 1299-1301. [xix] Cohen, p. 1301. [xx] Cappelen, p. 476-480. [xxi] Cappelen, p. 476-480. [xxii] Kawachi, I. (2005). Why the United States is not number one in Health. Healthy, Wealthy, and Fair, 18–33. https://doi.org/10.1093/acprof:oso/9780195170665.003.0013 [xxiii] Kawachi, p. 18-33. [xxiv] Kawachi, p. 18-33. (shrink)

It has been widely recognized since ancient times that a standard way to resolve disagreement is for one party to extract concessions from the other which he or she is less prepared to give up than his original thesis. Central to this methodology is specifying the various forms of consequence which bear on matters already conceded. Not all disagreements are responsive to this methodology. I shall speak of a class of disagreements as intractable when parties are unwilling to (...) “split the difference” or to “agree to disagree” and yet are unable to agree on procedures to resolve their original disagreement.. When intractable disagreements turn on values that are widely held and widely judged to be of the first importance, intractable disagreements constitute an apparent impediment to social policy formation. An urgent question is this: “Is coherent and supportable public policy possible concerning matters subject to intractable disagreement?”. (shrink)

Despite its prominence in the abortion debate and in public policy, the discourse of ‘unborn patient’ has not been subjected to critical scrutiny. We provide a critical analysis in three steps. First, we distinguish between the descriptive and normative meanings of ‘unborn child.’ There is a long history of the descriptive use of ‘unborn child.’ Second, we argue that the concept of an unborn child has normative content but that this content does not do the work that (...) opponents of abortion want it to do, namely, to establish the independent moral status of fetuses and their rights, the right to life in particular. Third, we argue that the normative content of ‘unborn child’ should be dependent moral status, not independent moral status. We conclude that the ethical concept of the fetus as a patient should replace the discourse of “unborn child” when that phrase is used normatively. (shrink)

Globally, a traditional management model has generally been used to manage disaster situations, including in Bangladesh. In Bangladesh, the government mostly uses the preparedness policy for pandemic outbreak case management. With regard to the limitations arising from the pandemic outbreak the current research will investigate the following questions: when facing a devastating situation, what exactly is the nature of the pandemic outbreak management model incorporated at the governmental level? Keeping these questions in mind, the intention of the existing (...) model is to provide smooth and appropriate assistance to recover from a pandemic outbreak, and to implement effective governance of the situation. This research will identify deficiencies in the current epidemic management policy in Bangladesh, and will assist in forming a new model and developing a systematic procedure for managing future pandemic outbreak situations. The main deficiency in Bangladesh’s pandemic management is that the policy paper has failed to identify all hazardous events that may occur in a pandemic outbreak. In most cases, it has underestimated the issues of bioethical responsibility toward the different stakeholders affected during the devastating situation of a pandemic outbreak. The policy does not emphasize the bioethical model; therefore, it fails to encourage support for either public protection or an ethically friendly management system. The model proposed in this article demonstrates an appropriate way to reduce or, if possible, avoid potential damages and losses from a pandemic outbreak. The model aims to prioritize the problems that need assistance to recover from the outbreak. (shrink)

Globally, a traditional management model has generally been used to manage disaster situations, including in Bangladesh. In Bangladesh, the government mostly uses the preparedness policy for pandemic outbreak case management. With regard to the limitations arising from the pandemic outbreak the current research will investigate the following questions: when facing a devastating situation, what exactly is the nature of the pandemic outbreak management model incorporated at the governmental level? Keeping these questions in mind, the intention of the existing (...) model is to provide smooth and appropriate assistance to recover from a pandemic outbreak, and to implement effective governance of the situation. This research will identify deficiencies in the current epidemic management policy in Bangladesh, and will assist in forming a new model and developing a systematic procedure for managing future pandemic outbreak situations. The main deficiency in Bangladesh’s pandemic management is that the policy paper has failed to identify all hazardous events that may occur in a pandemic outbreak. In most cases, it has underestimated the issues of bioethical responsibility toward the different stakeholders affected during the devastating situation of a pandemic outbreak. The policy does not emphasize the bioethical model; therefore, it fails to encourage support for either public protection or an ethically friendly management system. The model proposed in this article demonstrates an appropriate way to reduce or, if possible, avoid potential damages and losses from a pandemic outbreak. The model aims to prioritize the problems that need assistance to recover from the outbreak. (shrink)

The author draws on his own experience of helping to make and deliver public policy to indicate the wider context in which ethical decisions have to be made: the law, contested interpretations of the law which have to be settled in the courts, and wider political and economic factors. He argues that the concept of respect for the early embryo does have substance because of the strict regulatory regime of the Human Fertilisation and Embryology Authority (HFEA). He (...) considers the arguments that the early embryo ‘[e]njoys the full rights of the human being and should be accorded respect owed to a human being’. He concludes that these arguments are not finally convincing. He also looks at the moral status of the early embryo in Christian tradition and argues that perhaps from the fourth and certainly from the seventh century in the West until 1869, offences against the early embryo were regarded as less serious than offences against the embryo when developed further. For these reasons he concludes that there should be no absolute prohibition against research on an early embryo up to fourteen days. He also looks at recent cases involving pre-implantation diagnosis (PGD) and tissue typing with a view to obtaining matching tissue from an early embryo for a sibling suffering from a life-threatening disease. Although a distinction has been made between what might be licit in the case of a genetic disorder in the sibling but illicit if the disorder is not genetic, he argues that it could be in the best interests of the early embryo, the child that is to be, if in either case if it was selected with a view to matching the tissue of a sibling. (shrink)

Formal arguments have proven that avoiding the Repugnant Conclusion is impossible without rejecting one or more highly plausible population principles. To many, such proofs establish not only a deep challenge for axiology, but also pose an important practical problem of how policymaking can confidently proceed without resolving any of the central questions of population ethics. Here we offer deflationary responses: first to the practical challenge, and then to the more fundamental challenge for axiology. Regarding the practical challenge, we provide an (...) overview of recent literature that explores the implications for public policy of the Repugnant Conclusion and related puzzles within population ethics, and shows that there is more commonality in the implications of different population axiologies than is generally recognized. The upshot is that uncertainty about population ethics presents no important problem for policymaking, and the importance of population ethics to policymaking has been overstated. We then turn to more fundamental issues about axiology, and describe a new series of formal proofs that undermine the idea that any plausible axiology could avoid the Repugnant Conclusion, including those that are assumed to avoid it in the literature. The philosophical upshot is that the Repugnant Conclusion cannot plausibly be avoided, and so it is a mistake to assume as a constraint on a plausible axiology that it must be avoided, as is assumed by most of the literature in population ethics, including by all of the fundamental impossibility theorems. (shrink)

It seemed like only minutes after a team of Scottish scientists announced, in late February 1997, that they had successfully cloned a sheep, that governmental officials and private citizens throughout the world called for a ban on cloning human beings. The rush to legislate or issue executive orders was so swift, it is reasonable to wonder why the news that a mammal had been cloned ignited such a stampede to prohibit, even criminalize, attempts to clone humans. These events raise a (...) series of separate, yet related questions. Why does the prospect of cloning human beings incite such strong reactions? What reasons have been proposed for enacting national laws or international conventions to prohibit cloning? Can these prohibitions be justified by sound ethical arguments? Before attempting to answer these questions, let us look first at the responses that called for public policy measures to ban human cloning. (shrink)

This paper proposes a Capabilities -based Approach to guide hazard mitigation efforts. First, a discussion is provided of the criteria that should be met by an adequate framework for formulating public policy and allocating resources. This paper shows why a common decision-aiding tool, Cost-benefit Analysis, fails to fulfill such criteria. A Capabilities -based Approach to hazard mitigation is then presented, drawing on the framework originally developed in the context of development economics and policy. The focus of a (...) Capabilities -based Approach is protecting and promoting the well-being of individuals. Capabilities are dimensions of well-being and specified in terms of functionings. Functionings capture the various things of value an individual does or becomes in his or her life, including being alive, being healthy, and being sheltered. Capabilities refer to the real achievability of specific functionings. In the context of hazard mitigation, from a Capabilities -based Approach, decision- and policy-makers should consider the acceptability and tolerability of risks along with the affectability of hazards when determining policy formulation and resource allocation. Finally, the paper shows how the proposed approach satisfies the required criteria, and overcomes the limitations of Cost-benefit Analysis, while maintaining its strengths. (shrink)

Why, when confronted with policy alternatives that could improve patient care, public health, and the economy, does Congress neglect those goals and tailor legislation to suit the interests of pharmaceutical corporations? In brief, for generations, the pharmaceutical industry has convinced legislators to define policy problems in ways that protect its profit margin. It reinforces this framework by selectively providing information and by targeting campaign contributions to influential legislators and allies. In this way, the industry displaces (...) the public's voice in developing pharmaceutical policy. Unless citizens mobilize to confront the political power of pharmaceutical firms, objectionable industry practices and public policy will not change. Yet we need to refine this analysis. I propose a research agenda to uncover pharmaceutical influence. It develops the theory of dependence corruption to explain how the pharmaceutical industry is able to deflect the broader interests of the general public. It includes empirical studies of lobbying and campaign finance to uncover the means drug firms use to: (1) shape the policy framework adopted and information used to analyze policy; (2) subsidize the work of political allies; and (3) influence congressional voting. (shrink)

The United States Government does not mandate that US based firms follow US social and environmental law in foreign markets. However, because many developing countries do not have strong human rights, labor, and environmental laws, many multinationals have adopted voluntary corporate responsibility initiatives to self-regulate their overseas social and environmental practices. This article argues that voluntary actions, while important, are insufficient to address the magnitude of problems companies confront as they operate in developing countries where governance is often inadequate. (...) The United States can do more to ensure that its multinationals act responsibly everywhere they operate. First, policymakers should define the social and environmental responsibilities of global companies. They must consistently make their expectations for global business clear – and underscore that this objective can often be accomplished without mandates. Second, the US should closely examine the policies that undermine global Corporate Social Responsibility (CSR) and address the many conflicting signals sent by policymakers. Third, the President should make the US government a CSR model by examining how to use its purchasing power to promote human rights. Finally, the US government should require pension funds to report on the social and environmental consequences of their investments. In these ways, Americans can mind our business – and thus make sure that US based firms do not undermine social and environmental progress when they operate in the developing world. (shrink)

As corporate social responsibility involves a voluntary business endeavour to address social and environmental issues beyond legal compliance, governments cannot fall back on hierarchical command-and-control policies to support it. As such, it is complementary with the increasing popularity of public policies known as New Governance policies, where the government is engaged in a horizontal inter-organizational network of societal actors and where public policy is both formed and executed by the interacting and voluntary efforts from a multitude of (...) stakeholders. However, such policies are known to generate substantive uncertainty about the content of CSR and its related issues, strategic uncertainty regarding the behavior of the actors involved and institutional uncertainty related to the interaction process involved in the institutional change. We explore New Governance policy instruments to address these uncertainties in the context CSR and discuss the experiences with these methods in the European Union. (shrink)

One recurring criticism of the best interests standard concerns its vagueness, and thus the inadequate guidance it offers to care providers. The lack of an agreed definition of ‘best interests’, together with the fact that several suggested considerations adopted in legislation or professional guidelines for doctors do not obviously apply across different groups of persons, result in decisions being made in murky waters. In response, bioethicists have attempted to specify the best interests standard, to reduce the indeterminacy surrounding medical decisions. (...) In this paper, we discuss the bioethicists’ response in relation to the state's possible role in clarifying the best interests standard. We identify and characterise two clarificatory strategies employed by bioethicists —elaborative and enumerative—and argue that the state should adopt the latter. Beyond the practical difficulties of the former strategy, a state adoption of it would inevitably be prejudicial in a pluralistic society. Given the gravity of best interests decisions, and the delicate task of respecting citizens with different understandings of best interests, only the enumerative strategy is viable. We argue that this does not commit the state to silence in providing guidance to and supporting healthcare providers, nor does it facilitate the abuse of the vulnerable. Finally, we address two methodological worries about adopting this approach at the state level. The adoption of the enumerative strategy is not defeatist in attitude, nor does it eventually collapse into (a form of) the elaborative strategy. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Buddhist-Christian Studies 23 (2003) 117-131 [Access article in PDF] Conscience, Citizenship, and Global Responsibilities Richard Reilly St. Bonaventure University A version of this paper was presented at the Sixth International Conference of the Society for Buddhist-Christian Studies held at Pacific Lutheran University in Tacoma, Washington, in August 2000.Upon discovering that Antigone had buried her brother, Polyneices, King Creon ascertains that she indeed had known of his decree forbidding any (...) honor to be shown to the dead traitor, and asks, "You still dared break this law?" Antigone responds: Yes, because I did not believe that Zeus was the one who had proclaimed it; neither did Justice, or the gods of the dead whom Justice lives among. The laws they have made for men are well marked out. I didn't suppose your decree had strength enough, or you, who are human, to violate the lawful traditions the Gods have not written merely, but made infallible. These laws are not for now or for yesterday, they are alive forever; and no one knows when they were shown to us first. 1Thus arises the dynamic confrontation between conscience and the state in the guise of two very solitary individuals: Antigone, committed to her brother out of love and religious duty, and Creon, striving to reestablish political order so necessary to the welfare of the community. We might say, in the idiom of Saint Augustine and Martin Luther King Jr., for Antigone, "an unjust law is no law at all," or at least not one that should bind one's conscience. In his "Letter from Birmingham Jail," King agonized over the lack of support, much less solidarity, of the Christian community in the effort to achieve racial justice in America. Antigone is provided no comrade (although her sister, Ismene, is sympathetic); no one of religious authority pleads Antigone's case or provides her with moral support. In this respect, Antigone's situation is mirrored in that of Franz Jagerstatter, the Austrian Catholic beheaded for his refusal to be conscripted into the army in support of the Nazi's cause. [End Page 117]Surely, one owes much to one's state, especially if it is justly ordered, safeguards individuals' rights, and promotes the common good. Both out of gratitude and a sense of fair play, one should do one's "public duty"—including upholding the law, paying taxes, voting, and otherwise participating in the political life of the community, and so on. We might say, as Jesus said, "render unto Caesar what is Caesar's and render unto God what is God's." 2 What does not belong to Caesar is the nature, meaning, and destiny of one's life; or to put it otherwise, what does not belong to Caesar is the allegiance or fidelity of one's conscience. This paper has three aims: (1) to show that to be respectful of life entails "global responsibilities"; (2) to articulate a rational ground for the view that "life" and "conscience" do not belong to the state; and (3) to argue that religious communities should encourage and honor individuals of conscience and that the state should recognize as a fundamental human right a citizen's noncooperation with policies or behaviors that are life-destroying. That Buddhism and Christianity are "world religions" provides each with the opportunity and the responsibility to do whatever is possible to promote peace, prosperity, and well-being of all human beings. Buddhists and Christians would do well to join together to articulate "ethical responsibilities" in a culture-neutral way to underscore their independence from political structures and ideologies on the one hand and to emphasize their global applicability on the other. Respecting Life—a Global Precept Encountering spiritual traditions nourished in other cultures allows one to rethink one's cultural assumptions. The spread of Buddhism in the West is especially potent in this regard. One of the most fundamental of all moral laws is: "One ought not to kill." But what does this really mean? What does it require of each of us? Buddhism offers important insights in this regard. In what follows, I shall offer... (shrink)

The last 25 years have seen advances in our understanding of the neuroscience and neuropsychiatry of fear. From the basic brain mechanisms of fear to new evidence-based treatments for the pathologies of fear, the field has experienced progress towards an understanding of the underpinnings of fear in the brain and its influence on behaviors. Yet, to date, there has been less than ideal incorporation of these new findings, insights and models into the public policy and economic domains. Even (...) when notions of risk, uncertainty, and emotional decision-making are discussed, these discussions may not access insights from the latest contemporary neuroscience of fear, or clinical techniques in changing pathological fear responses. This paper will explore how a more complete incorporation of these advances may contribute to our understanding of fear and its management. Applying these advances in specific amenable policy areas may lead to new, more effective approaches to public and economic policies. (shrink)

Corporate social responsibility has become a potential path to legitimacy and improved public relations for both companies that produce mainstream products and those that sell vice, such as the tobacco industry. Since the early 1990s, the tobacco industry has sought to bridge the gap between the public perception it has earned as a merchant of death and its goal of gaining corporate legitimacy and normality by promoting programs, positions, and policies it hopes the general public will believe (...) are aimed at preventing or mitigating some of the societal ills that smoking causes, such as youth smoking. There is, however, an intractable problem that corporate social responsibility efforts can mask but not resolve: the tobacco industry’s products are lethal when used as directed, and no amount of public relations or funding of ineffective youth smoking prevention programs can reconcile that fundamental contradiction with ethical corporate citizenship. The focus of this study is to better understand the tobacco industry’s corporate social responsibility efforts and to assess whether there has been any substantive change in the way it does business with regard to the issue of exposure to secondhand smoke. (shrink)

One of the defining features of the capability approach to health, as developed in Venkatapuram's book Health Justice, is its aim to enable individual health agency. Furthermore, the CA to health hopes to provide a strong guideline for assessing the health-enabling content of social and political conditions. In this article, I employ the recent literature on the liberal concept of vulnerability to assess the CA. I distinguish two kinds of vulnerability. Considering circumstantial vulnerability, I argue that liberal accounts of vulnerability (...) concerned with individual autonomy, align with the CA to health. Individuals should, as far as possible, be able to make health-enabling decisions about their lives, and their capability to do so should certainly not be hindered by public policy. The CA to health and a vulnerability-based analysis then work alongside to define moral responsibilities and designate those who hold them. Both approaches demand social policy to address circumstances that hinder individuals from taking health-enabling decisions. A background condition of vulnerability, on the other hand, even though it hampers the capability for health, does not warrant the strong moral claim proposed by the CA to health to define health as a meta-capability that should guide social policy. Nothing in our designing social policy could change the challenge to health agency when we deal with background conditions of vulnerability. (shrink)

This paper addresses how states improve their responsiveness to violence against women in developing countries with little political will and few resources to do so. One key to engendering justice and improving responsiveness is building specialized institutions within the state that facilitate the implementation of laws addressing violence against women. Why and how do states engage in institution-building to protect marginalized populations in these contexts? I propose that developing countries are more likely to create and maintain specialized institutions when (...) domestic and international political and legal frameworks make the state more vulnerable to women’s demands, and when civil society coordinates with the state and/or international organizations to take advantage of this political opportunity. This coordination brings necessary pressure and resources that would be difficult, if not impossible, to deliver otherwise. This inter-institutional coordination is necessary for building and maintaining new state institutions and programs that help to monitor the implementation of laws, develop public policies, provide services for victims, and improve responsiveness of the justice system. This fills an important lacuna in the literature, which focuses on women’s state institutions as an important catalyst for responsiveness to violence against women, but does not explain how these institutions are initially constructed. (shrink)

Despite the relative ease and regularity with which it is used by policymakers and the functional role that it often plays in the policy development process, the concept of reasonableness has essentially been overlooked by public policy scholars in their analysis of the factors influencing the development of public policy. However, the maintenance of the analytical status quo is likely to prove increasingly difficult. As the issues that governments must address become increasingly complicated and controversial (...) and it becomes correspondingly more difficult to identify easily or clearly the most appropriate response to associated problems, policymakers will inevitably be forced to place greater reliance on the concept of reasonableness as the final court of appeal when seeking to determine the attractiveness and acceptability of policy decisions. Accordingly, it seems ‘reasonable’ to suggest that greater, explicit consideration be given to the concept of reasonableness and the role it does and should play in the development of public policy. This article simultaneously offers both a brief overview of the current situation with respect to the meaningful consideration of the concept of reasonableness by public policy scholars and practitioners and a preliminary argument for a reconsideration of the analytical status quo. (shrink)

The power exercised by technology companies is attracting the attention of policymakers, regulatory bodies and the general public. This power can be categorized in several ways, ranging from the “soft power” of technology companies to influence public policy agendas to the “market power” they may wield to exclude equally efficient competitors from the marketplace. This Article is concerned with the “data power” exercised by technology companies occupying strategic positions in the digital ecosystem. This data power is a (...) multifaceted power that may overlap with economic (market) power but primarily entails the power to profile and the power to influence opinion formation. While the current legal framework for data protection and privacy in the EU imposes constraints on personal data processing by technology companies, it ostensibly does so without regard to whether or not they have “data power.” This Article probes this assumption. It argues that although this legal framework does not explicitly impose additional legal responsibilities on entities with “data power,” it provides a clear normative indication to do so. The volume and variety of data and the reach of data-processing operations seem to be relevant when assessing both the extent of obligations on technology companies and the impact of data processing on individual rights. The Article suggests that this finding provides the normative foundation for the imposition of a “special responsibility” on such firms, analogous to the “special responsibility” imposed by competition law on dominant companies with market power. What such a “special responsibility” might entail in practice will be briefly outlined and relevant questions for future research will be identified. (shrink)

Two fundamental business ethics issues that repeatedly surface in the academic literature relate to business's role in the development of public policy [Suarez, S. L.: 2000, Does Business Learn? (The University of Michigan Press, Ann Arbor, MI); Roberts, R. W. and D. D. Bobek: 2004, Accounting, Organizations and Society 29(5-6), 565-590] and its role in responsibly managing the natural environment [Newton, L.: 2005, Business Ethics and the Natural Environment (Blackwell Publishing, Oxford)]. When studied together, researchers often (...) examine if, and how, corporations influence environmental policy decisions. Drawing from literatures on corporate political activity, corporate social and environmental performance, and corporate environmental disclosure, we develop and empirically examine two research questions concerning the relations between corporate political expenditures, environmental performance, and environmental disclosure. The questions are: (1) Do corporations that are poorer environmental performers spend more on political activities than their better-performing counterparts? (2) Is there an association between corporations' spending on political activities and the extent of their financial report environmental disclosures? We investigated these questions through analyses of data we gathered on a sample consisting of 119 U.S. environmentally sensitive firms for the 2001-2002 election cycle. After controlling for firm size and specific industry effects, our tests reveal a significant, inverse relationship between firm environmental performance and political spending. This is consistent with the notion that U.S. firms with relatively poorer environmental performance records engage more intensely in corporate political activities as part of their overall strategic management of their relationship with the state. In addition, a significant and positive association between the amount of political spending and the extent of environmental disclosure suggests that environmental disclosure and political spending are both proactive, complementary tactics to strategically manage public policy pressure. If corporations' strategies are intentionally designed to unreasonably limit their environmental responsibilities or to misrepresent firm environmental performance, then we argue that these activities reflect a significant lapse in ethical conduct. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.4 (2002) 381-382 [Access article in PDF] The Borderlands of Psychiatry and Theology Stephen Sykes Keywords: psychiatry, theology, spirituality. THE DISCUSSION OF THE TERMS we use to speak of experiences on the boundaries between spirituality and mental disorder is very important. Jackson and Fulford (1997) have gone a long way to avoid flattening the concepts into a single conceptual scheme, too far for some of (...) their critics like Littlewood (1997) and Storr (1997), but not far enough for Bratton and Marzanski (2002), who eventually accuse them of "anthropocentric psychologism." They want to preserve theological categories intact, mainly because this is how the subjects themselves see their experiences, but also because there is, they hold, additional explanatory value in such a language schema. As evidence they point to unremarkable attitudes and practices, which are nonetheless demonstrably part of the Christian way of life.The borderlands between theology and psychiatry are not alone in witnessing this dispute. A similar conflict has arisen in the discussion of public policy. In politics, people of religious conviction or representatives of faith communities have sometimes been told either to hold their tongues (because "not many people believe these things nowadays" or because "it's wrong to impose your beliefs on other people") or to formulate their proposals in nonreligious language. It is far from obvious that this is not a sophisticated form of discrimination, nonetheless objectionable for its being practiced by nonreligious people. The creation of genuine equality of access to the space for public discussion of political proposals is not at all easy.I have personal experience of the analogous difficulty in psychiatric practice. In a discussion of the overinvolvement of carers for a person with mental health problems self-sacrificing behavior was used with a negative connotation. But, as in the case of Carol, how were these actions to be construed—were they normal for a Christian or psychopathological? My personal response is that it is correct to say that a boundary exists between ordinary Christian spiritual experience (the kind that religious believers would immediately recognize as part of their religious lives) and disturbed or distorted perceptions that are the result of mental illness and can be mitigated by appropriate treatment. But the fact that a boundary exists in principle does not necessarily imply that it is always easy to draw the distinction in practice. Typically the cases that cause the most difficulty lie on the borderlands. Although on the face of it, it looks attractive to demonstrate the security of the criteria by making discriminations in precisely this area (and the point of the cases in Jackson and Fulford is precisely that they raise these complexities), in [End Page 381] fact it may be that such instances require both languages. In this case, Bratton and Marzanski are correct to argue for the retention of a theological frame of reference. The strength of their argument lies precisely in the support that fellow members of the respective faith communities are able to give to the people who, despite their manifest illnesses, persist in religiously justifiable courses of action.The paper raises one very important matter that bedevils a lot of the current literature, namely how spirituality is to be understood. In my view, there is a lot of purely arbitrary definition of this term, whose meaning has developed rapidly under specific social conditions (Sykes 2000a). In medicine, it functions best when it is taken to be a reminder that a patient may have had contact with a specific religious tradition that has contributed or still contributes to her worldview. In modern Western society, account has to be taken both of residual religiosities or fallback positions, and of new religions, as well as of traditional religious groupings. In the case of mental illness, it may be very important for a medical practitioner to be aware of the impact of these religious promptings on the formulation of the narrative identity of an individual—no easy task (Sykes 2000b).The generality of spirituality ought not to deflect the professional from attending to the particular tradition or traditions which have... (shrink)

Despite the relative ease and regularity with which it is used by policymakers and the functional role that it often plays in the policy development process, the concept of reasonableness has essentially been overlooked by public policy scholars in their analysis of the factors influencing the development of public policy. However, the maintenance of the analytical status quo is likely to prove increasingly difficult. As the issues that governments must address become increasingly complicated and controversial (...) and it becomes correspondingly more difficult to identify easily or clearly the most appropriate response to associated problems, policymakers will inevitably be forced to place greater reliance on the concept of reasonableness as the final court of appeal when seeking to determine the attractiveness and acceptability of policy decisions. Accordingly, it seems ‘reasonable’ to suggest that greater, explicit consideration be given to the concept of reasonableness and the role it does and should play in the development of public policy. This article simultaneously offers both a brief overview of the current situation with respect to the meaningful consideration of the concept of reasonableness by public policy scholars and practitioners and a preliminary argument for a reconsideration of the analytical status quo. (shrink)

We recently argued that—contrary to what we call the dominant view— physicians ought to avoid engaging patients on religious grounds.1 The six responses to our article present an array of concerns and have provided us with the opportunity to consider further aspects of our view. While we cannot reply to all the relevant issues, our aim here is to reply to the most significant concerns. Against our Public Reason Argument, Nick Colgrove maintains that physicians are not relevantly akin to (...) public officials and should therefore not be constrained by public reasons. Colgrove does not take issue with the idea that it may be reasonable for public officials to justify their policymaking according to public reasons because their policies affect a diverse population. But since ‘the [medical] decision being made is not binding for other patients,’ physicians need not be constrained by public reasons.2 Colgrove’s criticism hinges on the claim that deliberation ought to be constrained by public reason only if the outcome of such deliberation is a policy or a rule that a diverse group of people must follow. We disagree with this claim. We do not believe, nor did we argue, that this is a necessary condition for when we are morally required to cite public reasons. Instead we believe that three facts together provide sufficient reason for why physicians should generally be constrained by public reasons: physicians are directly and indirectly paid by the state via Medicare and Medicaid; physicians allocate public resources; and physicians are regulated by the state. Colgrove takes particular issue with our ‘Dr Chatterjee case’, which is meant to illustrate why citing religious reasons is inappropriate. And our explanation for why we find this case jarring …. (shrink)

How should International Political Theory (IPT) relate to public policy? Should theorists aspire for their work to be policy- relevant and, if so, in what sense? When can we legitimately criticize a theory for failing to be relevant to practice? To develop a response to these questions, I will consider two issues: (1) the extent to which international political theorists should be concerned that the norms they articulate are precise enough to entail clear practical advice under (...) different empirical circumstances; (2) whether they should provide concrete practical advice on policy choice and institutional reform. These questions are related but distinct, and we should answer each quite differently. Regarding the first, I shall argue that it counts heavily against a theory if it is not precise enough to guide policy and reform given certain empirical assumptions. On the second, I will argue that theorists should be very cautious when engaging with questions of policy and institutional design. Some principles of IPT can be criticized for being insufficiently precise, but a degree of abstraction from concrete policy recommendations is a virtue, rather than a vice, of an element of IPT. I conclude that we should aim to be precise without being concrete. To help fix ideas and anchor my argument, I will discuss these issues with reference to a principle that John Rawls has advocated in his influential work The Law of Peoples (Rawls 1999a): a duty of assistance to societies that lack the capacity to satisfy the basic needs or protect the basic rights of their people. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Religion and Public Policy: Human Rights, Conflict, and Ethics ed. by Sumner B. Twiss, Marian Simion, and Rodney L. PetersenJoshua T. MauldinReligion and Public Policy: Human Rights, Conflict, and Ethics Edited by Sumner B. Twiss, Marian Simion, and Rodney L. Petersen NEW YORK: CAMBRIDGE UNIVERSITY PRESS, 2015. 372 PP. $99.00This festschrift in honor of David Little canvasses the range of topics Little explored during (...) a distinguished career. The breadth of Little's research interests is reflected in the diversity of essays represented in the volume. Some of the seventeen chapters reflect directly on issues within Little's corpus while others discuss the influence Little had on various fields of inquiry or draw on his ideas for new areas of research.John Witte and Gene Outka provide essays of the first sort: Witte examines Little's work on the religious origins of human rights, while Outka raises questions about how Little's historical work on Reformed Protestantism relates to his work in human rights. Outka raises broader questions about methodology in religious ethics, questions also explored in a chapter by John Kelsay. These include foundationalism, the role of normativity in the study of religion, and the role of expressly theological concepts in religious ethics. The questions are intertwined but played out in different ways in Little's scholarly career; the first [End Page 224] two issues arose in response to the 1978 volume, Comparative Religious Ethics: A New Method, which was foundationalist in orientation. It sought to find the "basic" norm that was the ground of all other moral ideas in a religious system, whether Christianity, Buddhism, or the religion of the Navajo. Jeffrey Stout's critique of the book's foundationalist assumptions struck a serious blow to the project; in response, Little conceded so many of Stout's points that Stout questioned whether the methodology of the volume was meant to be taken seriously. As Kelsey notes in his chapter, some wondered whether the rigid methodology of Comparative Religious Ethics was created primarily to give religious ethicists a respectable job to do in an academic environment in which the study of religion was otherwise suspect. It sought to create a neo-Weberian study of religious ethical systems in which the scholar bracketed out her own ethical assumptions. Through this "value-free" descriptive science, the comparative ethicist hoped to gain admission to the secular academy. Foundationalism was meant to provide the kind of objectivity that gave the religious ethicist something objective to study. Giving up foundationalism would mean giving up the hope of comparative religious ethics as a science.This brings us to the role of distinctly theological claims in Little's work. When putting on the normative hat of the ethicist, Little preferred to bracket out theological assumptions, precisely in order to maintain conversation with his nonreligious interlocutors. The benefits of such a method are evident in this volume. Little managed to engage in moral and political conversation with scholars across a variety of religious, political, and national locations. As is clear in Little's afterword to this volume, he believes that bracketing out his first-order theological assumptions made this dialogue possible. But how can we be sure that this is the case? Perhaps other intellectual and moral virtues allowed this dialogue to flourish, and perhaps Little's virtues would have made such a dialogue possible, even had he been more open about his theological assumptions all along the way. It's hard to know for sure. But in light of the difficulties involved in bracketing out first-order theological assumptions, perhaps the better option is to make one's assumptions explicit while remaining willing to change one's mind when given compelling reasons to do so. That, it seems to me, is what it means to be reasonable—and this is compatible with holding theological beliefs. [End Page 225]Joshua T. MauldinCenter of Theological InquiryCopyright © 2017 Society of Christian Ethics... (shrink)

As the world becomes hotter and natural disasters increase, the challenge for survival will become greater. We need to become increasingly resilient. This has implications for how we see ourselves, others and the environment. What is consciousness? If it is more than the firing of an assemblage of neurons in our brain , how does it relate to mindfulness? What is the link between mindfulness, wellbeing and the global commons? Where do we -- indeed should we -- draw the (...) lines of inclusion and exclusion when we consider needs and responsibilities for sustainable futures? Do we have a choice between isolation in zero sum competitive nation states or finding ways to achieve multilateralism? Can mindfulness be enhanced through participation? How could intersubjectivity and expanding our relationships across self-other and the environment change our attitude towards representation, accountability and sustainable futures? The paper reflects on the extent to which participation is an end in itself, in other words that participation enables people to have a greater understanding of one another and a better match of services to needs. It addresses past research aimed at enhancing public policy conducted over the past twenty years and draws on current research into ways to enhance communication and mindfulness to promote wellbeing and resilience. This is addressed through combining cycles of open and structured dialogue guided by e- democracy and e-governance software to inform decision making by both users and providers. It creates updated data which are used only as a guide to inform decisions and as an aid to address complex problems. New approaches to social policy and governance challenges will need to be timely, inclusive and responsive to global citizens. (shrink)

Does science have a place when it comes to making public policy? The answer might not be as simple as many people think. Ideally, scientists discover facts, and those facts inform policy. But policy undermines the open-ended nature of scientific inquiry, and scientists end up representing an agenda rather than presenting objective truths to be used to make decisions that impact the public. Through a variety of perspectives, this volume explores who wins and (...) who loses when science and politics mix. (shrink)

The concept of innovation defines our age. It fuels the global economy, promises a sustainable future, and stands at the heart of our interconnected society. On the one hand, the concept of innovation is widely presupposed in terms of the commercial value it generates. As claimed in the tradition of economic analysis, innovation is characterized by its competitive dynamics and primarily directed at developing marketable products and services. On the other hand, the reality of today’s global issues, such as climate (...) change and food security, urges innovation to generate societal value beyond mainstream economic incentive. To this end, the EU policy discourse has paved the way for Responsible Innovation. The core idea here is to steer innovation processes towards societally desirable outcomes, specifically in response to the ‘grand challenges’ of our time. Under the sway of ‘science with and for society’, the hypothesis is that innovation can only respond to the needs and ambitions of society by including all its actors throughout the process. However, while much effort is dedicated to governing innovation, little thought goes to what innovation itself means conceptually. What understanding of innovation underpins the framework of RI? What implications, if any, does this have for the ambition to achieve RI? These are important questions to raise as they enable critical reflection on the relation between responsibility and innovation, broadly speaking. Does the ‘R’ in RI entail an application of ethical keys to an already existing concept of innovation, or does it require us to rethink the concept of innovation altogether? After providing a general introduction in chapter 1 on the context of the dissertation and its main research objectives, chapter 2 shows how RI emerged from a longer history of efforts to incorporate ethical dimensions in new and emerging technologies, such as Technology Assessment and Science and Technology Studies. While similar to its precursors in prioritizing ethical concerns, RI clearly distinguishes itself by shifting from an ethics of constraints to an ethics of construction. The chapter continues to show that such an approach comes with an epistemic challenge, a political challenge, and a conceptual challenge. Through an extensive analysis of policy documents and academic literature, chapter 3 breaks open the concept of innovation in the RI discourse. Firstly, it demonstrates that the RI discourse tends to presuppose a techno-economic concept of innovation, as coined by the terms ‘technological innovation’ and ‘commercialized innovation’. Secondly, it provides a historical analysis to show that the concept of innovation was originally politically oriented and had little to do with the way in which it is commonly understood today. Thirdly, it discusses the implications of a techno-economic concept of innovation for achieving the ideal of RI and brings into question whether the political origins of innovation may inspire an alternative route. Chapter 4 engages with the philosophy of technology to assess the feasibility of RI at both an ontic and ontological level. While innovation at the ontic level refers to concrete innovative artefacts, innovation at the ontological level refers to the mode through which these artefacts are seen, understood, and created. At the ontic level, RI is shown to play a significant role in steering emerging technologies towards societally desirable outcomes. Even so, at the ontological level, the question is whether the ideal of RI is feasible insofar its scope is limited to governing a techno-economic concept of innovation. Parallel to Martin Heidegger’s view of technology as Enframing, this chapter denotes that in trying to govern a techno-economic concept of innovation, the RI discourse remains subject to its dominance. This in turn explains why, at the operational level, RI is often employed for mere strategic and instrumental purposes, while falling short on its promoted ambitions. Chapter 5 articulates an orientation shift from a techno-economic concept of innovation towards a political concept of innovation in the RI discourse. To this end, the chapter distinguishes between weak RI, which seeks to govern a techno-economic concept of innovation through an applied set of ethical dimensions; and strong RI, which seeks to conceive a political concept of innovation beyond techno-economic ideology and practice. Inspired by the work of Hannah Arendt, the chapter establishes a political concept of innovation that actualizes the human capacity for speech and action, inspires radical novelty, and empowers the public sphere. In doing so, the chapter concludes that strong RI is principally a plural undertaking which guards individual opinion from collective opinion; enables a physical and symbolic openness that genuinely activates citizenry; and stimulates performative speech. The final chapter, chapter 6, briefly recaps the main research objectives and takes stock of the insights gained. It concludes that the contribution of this dissertation does not reside in the concern with the techno-economic ideology of innovation as such – a concern which RI in fact already expressed when it first emerged – but more so in the ontological critique to the idea that this ideology can somehow be overpowered through governance and regulation. The rehabilitation of an ontological dimension in RI in turn provides a new perspective to the philosophy of technology, which over the years has taken a course away from ontological viewpoints. Moreover, the chapter elaborates on how a political concept of innovation adds depth to the foundational claims of RI. Based on these conclusions, the chapter reflects on a range of broader insights, particularly in relation to the philosophy of innovation and the ethics of socially disruptive technologies. In sum, this dissertation politicizes the RI discourse precisely in the way it was originally envisioned, that is, through conceptualizing innovation as a fundamentally political matter. In this view, politics is not merely an extension of RI but is itself the condition of RI; it is what enables innovation to genuinely serve the public good. (shrink)

Zakat is a monetary form of religious worship that establishes a bridge between a rich and a poor, helps those who are in need and contributes to peace and tranquillity within a society. When zakat is collected properly under a government control and transmitted to those who deserve, it helped to decrease the gap between the poor and the rich, supported activities of social solidarity and revived the economy as well. Malaysia after its independence in 1957 has developed an (...) interest in Islamic practices by drawing attention to a distinctive practice with the public zakat system. Even though a national- central system of zakat could not be established due to the federal structure of the country, the collection and distribution of zakat has been centralized on a state level. Parts of the practice are being criticized, reviewed and new regulations are introduced. Unlike Malaysia, the zakat practice in Turkey is out of state control, thus it hinders zakat from achieving its real purpose. There is a need to make use of the well-functioning zakat systems around the world and establish a public zakat system in our country so that we can make the most of the benefits that zakat has for individuals and societies. This article aims to be a step in that direction. -/- SUMMARY Zakat is one of the main forms of worship and is at the same time one of the main sources for the state budget in Islam. It aims at making sure that the rich –those with higher wealth and income– protects the poor and the powerless and through this it contributes to the peace in the society. In the Islamic creed wealth in reality belongs to Allah; therefore, those who live an affluent life should not attribute their wealth to themselves alone and help those who, for whatever reason, are unable to meet their needs. Because there is a social dimension to this form of worship, it is the duty of the head of state to collect the zakat and distribute it to the right people. Historically this duty has taken different forms and today, many Muslim countries sustain this collection and redistribution under state supervision. Malaysia is a country where zakat is collected and distributed officially at the state level. In each state, there is an Islamic council responsible for taking care of activities related to Islam and is semi-independent from the government that organizes the zakat process. Some of these do the collection and distribution together, some do it separately. In some states, the process has been totally privatized. Constitutionally, each state is dependent on its own sultan in religious affairs, thus each has its own mufti and partially different zakat practices and eac collect and distributes its zakat within that state. Because religious affairs have been codified as the privilege of the sultans of each state in the constitution during Malaysia’s foundation, there is no attempt at centralizing religious affairs and a centralization of zakat practices; the establishment of an institution to achieve this is not possible. Moreover, the secular character of the federation does not seem yet compatible with making zakat obligatory. However, due to the dominant Shafi‘i tradition and the convention in the country, people see it as imperative to hand over the charity and tithe to state institutions. Furthermore, there are local fatwas – which are considered as legal regulations in Malaysia – that require people with an income over a certain amount to pay zakat. Those who have the most are expected to give it voluntarily. In the 19th century, when wealth sources such as palm oil, cacao, rubber, tin were discovered, Malaysian officials were not able to extend the tithe to these; however, in the last twenty-five years, based on fatwas that income should be taxable under zakat has led to a boom in zakat. In all states, the largest portion of zakat is collected through income, usually automatically deducted from payroll. An influential factor in this outcome is that individually paid zakat can be deducted from income tax. From 2005 on, there have been other regulations to make it possible for legal personalities to deduct zakat from taxes. To increase zakat payment, especially publications have been produced to inform and encourage people, and modern opportunities to make payment easy have been developed. The most often used method is direct deduction from payroll. The second most common method is payment through zakat machines in different parts of the city by cash, check, Islamic credit card and, debit card. In addition to these, online, internet banking, telephone banking, ATM machines, post offices, kiosk machines, sms-zakat options are all available. The distribution of zakat differs from year to year and state to state. In general, there is an observable effort to pay all groups from zakat, but because there are no slaves in some states no payment is done under this category. There are both direct transfers and indirect transfers, such as through the construction of houses for poor people. There have been cases where poor people who had projects were supported with funds and those later returned in zakat. There is support for students in terms of scholarships through fuqarā’, fī sabīl allāh and ibn al-sabīl classes. For the muallafa al-qulūb class, there is a foundation to encourage local people to convert to Islam and help them for food, shelter, clothes and education. For Muslims who suffer as minorities in other countries help is provided through the riqāb, muallafa al-qulūb, fī sabīl allāh and ibn al-sabīl classes. In the ghārimīn class, especially victims of natural disasters such as flood and earthquake are supported. For those who have a right to receive zakat be able to receive it, the state has to side with the powerless and help zakat fulfill its social and individual functions. The way zakat is spent requires state policy and will. For this reason, zakat should be institutionalized and all activities should be organized by a single institution with state power behind it. Determining the recipients and the zakat-payers, and using the funds efficiently is easier with the coordination of state institutions. Extensive zakat councils that include state institutions should consider the ijtihāds in the area of zakat anew and make decisions to create a just and consistent zakat system. For these decisions to be applicable, the question of what kind of a system could be founded in our country should be on the agenda in these councils. Once an institution – official or autonomous but with state power behind it- is created, solutions can be found as they arise in the way. (shrink)

This article maintains that it is the constitutional responsibility of the courts, here the courts of the State of Michigan, to engage in judicial policymaking in the process of formulating common law rules. The article is written in response to the views expressed by some Justices of the Michigan Supreme Court that separation of powers concerns should impose significant limits on the power of the courts to establish and develop the common law of Michigan. Specifically, the contention is that policymaking (...) is exclusively the province of the legislature, so that the courts cannot properly formulate common law rules that may have significant social and economic effects. The article strongly disagrees with the proposition that there is any kind of constitutional constraint, either prudential or structural, on the power, and indeed, the constitutional responsibility of the Michigan courts (or the courts of any state) to engage in judicial policymaking in the process of formulating common law rules.The judicial power given to the Michigan courts by the Michigan Constitution includes the power to do what courts have always done in the Anglo-American legal system. The judicial power gives the courts the responsibility to adjudicate controversies between private persons and in the process to develop a common law through the workings of binding precedent and stare decisis. In so doing, the courts may properly take into account considerations of social and economic policy just as the legislature does when it engages in the process of enacting legislation. The difference between what the courts do and what the legislature does is a difference in process, not a difference in substance. Judicial policymaking takes place within the judicial process, that is, in the adjudication of controversies between persons in which the courts promulgate common law rules. The common law develops in a line of growth through the workings of binding precedent and stare decisis, and to the extent that there are limitations on the development of the common law, these are limitations that inhere in the judicial process itself. When the courts, for example, consider whether a new claim or a new defense should be recognized by the common law, they must consider whether that new claim or defense properly follows in the line of growth from existing doctrine and precedent. But if the courts conclude that it does, that is, if the claim or defense is consistent with the line of growth of existing doctrine and precedent, the courts are not constrained from recognizing the claim or defense on the ground that the substance of the claim or defense is a matter for the legislature rather than for the courts or that the resulting common law rule may have significant social and economic effects. The legislature, in contrast, enacts legislation through the legislative process. That process is a freewheeling one, often dependent on political compromise and completely unrestrained by the kind of limitations that inhere the judicial process. There is no legislative concept of line of growth, and the legislature can and often does enact legislation that brings about fundamental societal change or reverses the course of public policy. In our constitutional system, the most important questions of public policy are, of course, determined by the Legislature. Where the legislature disagrees with the policy choices reflected in a common law rule, the legislature has the power to enact legislation changing the common law rule. But there are many areas of private law where the legislature has not acted. In our constitutional system, where the matter in issue is not covered or preempted by legislation, the courts may formulate a common law rule to cover that matter, and in so doing may engage in judicial policymaking. Judicial policymaking is a part of the development of the common law, and the courts cannot avoid their responsibility to engage in judicial policymaking to the extent that it is necessary in the process of formulating the common law. As a constitutional matter, there are no separation of powers considerations that prohibit the courts from engaging in judicial policymaking. This part of the article traces judicial policymaking and the common law back to the seminal writings of Oliver Wendell Holmes, Roscoe Pound and Benjamin Cardozo.The article then discusses at length judicial policymaking and the development of the common law in Michigan. It shows that the clearest history of judicial policymaking in development of the common law is the liability-limiting rules of the late nineteenth century that were promulgated in the wake of the Industrial Revolution to protect the newly-emerging industries. During that time the courts in Michigan and elsewhere grafted on to the general principles of negligence law liability rules such as assumption of risk, contributory negligence, and the fellow servant doctrine, all of which had the effect of denying recovery to workers and other victims of industrial accidents. Beginning in the middle of the twentieth century, however, the Michigan Supreme Court began excising its constitutional power to make changes in the common law, expanding significantly the scope of tort liability in Michigan. Emphasizing that "rules created by the court could be altered by the court," and that the court had a "corrective responsibility when dealing with judge-made law," the Court, in approximately a 30 year period: eliminated the imputed negligence doctrine, under which the driver's negligence was imputed to the passenger in the passenger's suit against a third party; eliminated charitable immunity as a defense to a tort action; held that a wife could maintain at tort action for loss of her husband's consortium; abrogated the defense of assumption of risk, which had been applied outside of the employment area, held that there could be recovery for pre-natal injuries and finally abolished contributory negligence as a complete bar to recovery in favor of a comparative negligence approach. In these cases the Court discussed the relevant policy considerations influencing their decisions with respect to the common law rule at issue. In the last quarter century, the Court continued to take into account policy considerations in developing the common law, but not infrequently there was disagreement on the Court as to where policy considerations should lead, with some Justices arguing that policy considerations supported the imposition of tort liability, while other Justices argued that they did not.The article concludes that it has been demonstrated that in the development of the common law of Michigan, the Michigan Supreme Court has at all times engaged in judicial policymaking. From the liability-limiting rules of the late nineteenth century designed to protect the newly-emerging industries in this state, to the Court's exercise of its power to change the common law in Michigan over a 30 year period by expanding significantly the scope of tort liability in Michigan, to its recognition of new claims, such as a child's right to recover for loss of a parent's consortium caused by a negligent injury, to its imposition of limits on tort recovery, such as the open and obvious doctrine, the Court has invoked considerations of policy in support of its decisions. In these cases, the Court's invocation of policy considerations was sometimes accompanied by substantial disagreement among members of the Court over where policy should lead, but at no time did the Court ever suggest that separation of powers considerations should somehow operate as a kind of restraint on the Court's use of policy in the development of the common law. It is the power and responsibility of the Michigan Courts under the Michigan Constitution to make policy choices in formulating the common law. (shrink)

Many scholars claim that democracy improves population health. The prevailing explanation for this is that democratic regimes distribute health-promoting resources more widely than autocratic regimes. The central contention of this article is that democracies also have a significant pro-health effect independently of public redistributive policies. After establishing the theoretical plausibility of the non-distributive effect a panel of 153 countries for the years 1972 to 2000 is used to examine the relationship between extent of democratic experience and life expectancy. We (...) find that democratic governance continues to have a salutary effect on population health even when controls are introduced for the distribution of health-enhancing resources. Data for 50 autocratic countries for the years 1994 to 2007 is then used to examine whether that press freedom has a positive impact on life expectancy independently of government responsiveness. (shrink)

This essay assesses the possibilities for poetic-liturgical compositions, such as requiems, to promote Christian public engagement when legal frameworks are perceived to be inadequate for securing justice. This essay addresses the perception that legal statutes and procedures failed to honor the personhood of two particular African American males and discusses how aesthetic responses have been used to counter the devaluing of their lives. One such response, Marilyn Nelson's poem Fortune's Bones: The Manumission Requiem, questions the law's failure to (...) protect an eighteenth-century enslaved man. Another requiem memorializes Michael Brown after the teen's killing by a police officer in 2014. This essay discusses these particular aesthetic responses and then evaluates the possibilities for the requiem as a Christian practice of civic engagement by appropriating Charles Mathewes's articulation of hopeful citizenship. In cases when the law is perceived to be complicit in devaluing African American personhood, liturgy can be a meaningful Christian response. (shrink)

This paper acts as an introduction to a dossier centered on the ethical implications of Practicing Philosophy with Children and Adults. It identifies ethical themes in the P4C movement over three generations of theorists and practitioners, and argues that, historically and materially, the transition to a “new” hermeneutics of childhood that has occurred within the P4C movement may be said to have emerged as a response to the ever-increasing pressure of neoliberalism and a weaponized capitalism to construct public policies (...) in education on an over-regulated, prescribed, state-monitored, model. Could a new relationship to childhood provide the ethical and political agenda that our times require for doing philosophy with children with integrity? Could a radical listening and openness to childhood—which has been an intrinsic confessional characteristic of P4C pedagogy from the beginning--sustain the movement through these dark times? Finally, the paper presents a set of articles written in response to these questions: What, if any, should the ethical commitments of the P4C facilitator be? Is political/ideological neutrality required of the P4C facilitator? Is political neutrality possible? What constitutes indoctrination in educational settings? Are children more vulnerable to indoctrination than adults, and if so, what are the implications of that fact for the practice of P4C? What are the uses of P4C in the dramatically polarized ideological landscape we currently inhabit? What, if any, are the ethical responsibilities of a teacher engaging in philosophical practice? Are the philosophical practitioner’s ethical responsibilities similar or different when the subjects are children or adults? Does every methodology have a “hidden curriculum”? If so, what is the hidden curriculum of P4C? What distinguishes dialogical from monological practice? May one have the appearance of the other? Is the “Socratic method” as we conceive it dialogical? What, if any, are the uses of irony in philosophical practice? Should Socrates be considered a model for P4C practitioners? (shrink)

Controversial Supreme Court decisions have barred organized school prayer, but neither the Court nor public policy exclude religion from schools altogether. In this book, one of America's leading constitutional scholars asks what role religion ought to play in public schools. Kent Greenawalt explores many of the most divisive issues in educational debate, including teaching about the origins of life, sex education, and when--or whether--students can opt out of school activities for religious reasons. Using these and other (...) case studies, Greenawalt considers how to balance the country's constitutional commitment to personal freedoms and to the separation of church and state with the vital role that religion has always played in American society. Do we risk distorting students' understanding of America's past and present by ignoring religion in public-school curricula? When does teaching about religion cross the line into the promotion of religion? Tracing the historical development of religion within public schools and considering every major Supreme Court case, Greenawalt concludes that the bans on school prayer and the teaching of creationism are justified, and that the court should more closely examine such activities as the singing of religious songs and student papers on religious topics. He also argues that students ought to be taught more about religion--both its contributions and shortcomings--especially in courses in history. To do otherwise, he writes, is to present a seriously distorted picture of society and indirectly to be other than neutral in presenting secularism and religion. Written with exemplary clarity and even-handedness, this is a major book about some of the most pressing and contentious issues in educational policy and constitutional law today. (shrink)

Background: Pediatrics ethics education should enhance medical students' skills to deal with ethical problems that may arise in the different settings of care. This study aimed to analyze the ethical problems experienced by physicians who have medical education and pediatric care responsibilities, and if those problems are associated to their workplace, medical specialty and area of clinical practice. Methods: A self-applied semi-structured questionnaire was answered by 88 physicians with teaching and pediatric care responsibilities. Content analysis was performed to analyze the (...) qualitative data. Poisson regression was used to explore the association of the categories of ethical problems reported with workplace and professional specialty and activity. Results: 210 ethical problems were reported, grouped into five areas: physician-patient relationship, end-of-life care, health professional conducts, socioeconomic issues and health policies, and pediatric teaching. Doctors who worked in hospitals as well as general and subspecialist pediatricians reported fewer ethical problems related to socioeconomic issues and health policies than those who worked in Basic Health Units and who were family doctors. Conclusions: Some ethical problems are specific to certain settings: those related to end-of-life care are more frequent in the hospital settings and those associated with socioeconomic issues and public health policies are more frequent in Basic Health Units. Other problems are present in all the setting of pediatric care and learning and include ethical problems related to physician-patient relationship, health professional conducts and the pediatric education process. These findings should be taken into consideration when planning the teaching of ethics in pediatrics.Trial registrationThis research article didn't reports the results of a controlled health care intervention. The study project was approved by the Institutional Ethical Review Committee (Report CEP-HIJG 032/2008). (shrink)

Government food and beverage policies can play an important role in promoting public health. Few people would question this assumption. Difficult questions can arise, however, when policymakers, public health officials, citizens, and businesses deliberate about food and beverage policies, because competing values may be at stake, such as public health, individual autonomy, personal responsibility, economic prosperity, and fairness. An ethically justified policy strikes a reasonable among competing values by meeting the following criteria: the policy (...) serves important social goal; the policy is likely to be effective at achieving those goal; less burdensome options are not likely to be effective at achieving the goals; the policy is fair. (shrink)

In an effort to contain the spread of COVID-19, many states and countries have adopted public health restrictions on activities previously considered commonplace: crossing state borders, eating indoors, gathering together, and even leaving one’s home. These policies often focus on specific activities or groups, rather than imposing the same limits across the board. In this Article, I consider the law and ethics of these policies, which I call tailored policies. In Part II, I identify two types of tailored policies--activity-based (...) and group-based. Activity-based restrictions respond to differences in the risks and benefits of specific activities, such as walking outdoors and dining indoors. Group-based restrictions consider differences between groups with respect to risk and benefit. Examples are policies that treat children or senior citizens differently, policies that require travelers to quarantine when traveling to a new destination, and policies that treat individuals differently based on whether they have COVID-19 symptoms, have tested positive for COVID-19, have previous COVID-19 infection, or have been vaccinated against COVID-19. In Part III, I consider the public health law grounding of tailored policies in the principles of “least restrictive means” and “well-targeting.” I also examine how courts have analyzed tailored policies that have been challenged on fundamental rights or equal protection grounds. I argue that fundamental rights analyses typically favor tailored policies and that equal protection does not preclude the use of tailored policies even when imperfectly crafted. In Part IV, I consider three critiques of tailored policies, centering on the claims that they produce inequity, cause harm, or unacceptably limit liberty. I argue that we must evaluate restrictions comparatively: the question is not whether tailored policies are perfectly equitable, wholly prevent harm, or completely protect liberty, but whether they are better than untailored ones at realizing these goals in a pandemic. I also argue that evaluation must consider indirect harms and benefits as well as direct and apparent ones. (shrink)

With the rapid development of genetic research and applications in health care there is some agreement among funding and regulatory bodies that the public(s) need to be equipped to deal with the choices that the new technologies will offer them, although this does not necessarily include a role for the public in influencing their development and regulation. This paper considers the methods and purpose of public consultations in the area of genetics including large-scale surveys of opinion, (...) consensus conferences and focus groups. Consultation has been undertaken to enable the researchers/policy makers to see what the public do not know and plan more public education to make up the deficiency, to check on areas of concern so that public education can be used to address them or to gain a public mandate for a planned policy. An alternative and more recent approach is to find out what the public(s) do know and understand and to see how experts can learn from them in order to get a fuller view of technology in use. (shrink)

In this essay I argue that the same considerations that justify the strong commitment to anti-paternalism that has been affirmed in bioethics over the past half century, also calls for anti-paternalistic public health policies. First, I frame the puzzle—why are citizens morally entitled to make unhealthy and medically inadvisable decisions as patients but not as consumers? I then briefly sketch the reasons why bioethicists typically reject paternalism. Next, I argue that those same reasons tell against paternalism in public (...) health ethics as well. Patients do not waive their rights to make medically inadvisable decisions when they leave their physician’s care. James Wilson disagrees. After I sketch Wilson’s arguments for paternalism in public health policy, I then argue, contra Wilson, that public health paternalism is wrong for the same reason that medical paternalism is wrong, and that the prevalence of paternalism in public policy does not mean that paternalism is morally permissible. I discuss the state’s authority to enforce paternalistic policies and I sketch an anti-paternalist vision for health policymakers. To close, I consider several objections. (shrink)

Little is known on the appraisal of ethically questionable not- for-profit actions such as social marketing advertising campaigns. The present study evaluates the ethical acceptance by adults of anti-obesity threat appeals targeting children, depending on the claimed effectiveness of the campaign. An experiment conducted among 176 Belgian participants by means of an online survey shows that individuals’ acceptance of social marketing practices increases along with the claimed effectiveness of the campaign. As such it demonstrates that the audience adopts a pragmatic (...) perspective, challenging the non-consequentialist stance of social marketers who refrain themselves from using these ‘questionable’ techniques although highly effective. The trade-off between ethical judgment and claimed effectiveness varies depending on whether the threats focus on the child’s physical integrity or social life. Individual characteristics such as parenthood and age also influence the relationship. All in all, it seems that people with stronger connections to the issue such as parents are more ready to compromise. These findings enrich our insights into consequentialism in social marketing campaigns, how people respond to controversial messages targeted at vulnerable group, and open new venues to social managers and public policy makers. Managerial implications and concrete advice on how to communicate with the various audiences are proposed, as well as suggestions for future studies. (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)

In this chapter we address what we call “The-Everybody-Did-It” (TEDI) Syndrome, a symptom for collective negligence. Our main thesis is that the character of scientific communities can be evaluated morally and be found wanting in terms of moral responsibility. Even an epistemically successful scientific community can be morally responsible for consequences that were unforeseen by it and its members and that follow from policy advice given by its individual members. We motivate our account by a critical discussion of a (...) recent proposal by Heather Douglas. We offer three, related criticisms of Douglas’s account. First, she assumes that scientific fields are communicative communities. Second, in a system where the scientific community autonomously sets standards, there is a danger of self-affirming reasoning. Third, she ignores that the character of a scientific community is subject to moral evaluation. We argue that these omissions in Douglas’s theory leave it with no adequate response to TEDI Syndrome. Moreover, we deny that science ought to be characterized by unanimity of belief among its competent practitioners, this leads easily to the vices of close-mindedness and expert-overconfidence. If a scientific community wishes to avoid these vices it should create conditions for an active pluralism when it and its members aspire to the position of rational policy decision-making. (shrink)

With the rapid development of genetic research and applications in health care there is some agreement among funding and regulatory bodies that the public need to be equipped to deal with the choices that the new technologies will offer them, although this does not necessarily include a role for the public in influencing their development and regulation. This paper considers the methods and purpose of public consultations in the area of genetics including large-scale surveys of opinion, (...) consensus conferences and focus groups. Consultation has been undertaken to enable the researchers/policy makers to see what the public do not know and plan more public education to make up the deficiency, to check on areas of concern so that public education can be used to address them or to gain a public mandate for a planned policy. An alternative and more recent approach is to find out what the public do know and understand and to see how experts can learn from them in order to get a fuller view of technology in use. (shrink)