The article presents a portrait and analysis of the existential-psychocultural situation in postmodern Sweden. Drawing from recent research exploring psychology of religion and existential worldviews, and the Swedish findings from the international World Values Survey, an argument is made for thinking about existential function and dysfunction as public health issues. This is portrayed against the background of Sweden as one of the most secularized countries and simultaneously a country with one of the most encompassing welfare (...) systems. Psychology of religion's updated role here would be to take responsibility for identifying and assessing the categories of function and dysfunction for an existential public health system. This role would also include the planning of policy for societal existential wellbeing, as well as planning prevention and intervention efforts for avoiding existential epidemiology. This new role fits well with public health's third revolution agenda focusing on health, wellbeing and quality of life. (shrink)

This book presents the first critical examination of the overlapping ethical, sociocultural, and policy-related issues surrounding disasters, global bioethics, and public health ethics. These issues are elucidated under the conceptual rubric: Public health disasters. The book defines PHDs as public health issues with devastating social consequences, the attendant public health impacts of natural or man-made disasters, and latent or low prevalence public health issues with the potential to rapidly acquire pandemic (...) capacities. This notion is illustrated using Ebola and pandemic influenza outbreaks, atypical drug-resistant tuberculosis, and the health emergencies of earthquakes as focal points. Drawing on an approach that reckons with microbial, existential, and anthropological realities; the book develops a relational-based global ethical framework that can help address the local, anthropological, ecological, and transnational dynamics of the ethical issues engendered by public health disasters. The book also charts some of the critical roles that relevant local and transnational stakeholders may play in translating the proposed global ethical framework from the sphere of concept to the arena of action. This title is of immense benefit to bioethics scholars, public and global health policy experts, as well as graduate students working in the area of global health, public health ethics, and disaster bioethics. (shrink)

This article presents a descriptive, interpretive theory of ethical responsibility in public health nursing. The theory is based on qualitative empirical studies, a purposeful literature review and meta-ethnography of public health nurses’ experiences of ethical responsibility, interpreted within a philosophical framework. Levianasian philosophy provides the main direction for the authors’ interpretations. The path for theory development consists of three phases: an inspirational phase, an explorative phase and the third phase ‘ joining the dots’. The theory illustrates (...) that ethical responsibility in public health nursing is related to the life existentials of temporality and human relationships. Due to blurred boundaries in these essential life structures, public health nurses can experience a sense of satisfaction but also worries, uncertainties and loneliness. The study reveals paradoxical connections between fear and courage, and between freedom, autonomy and a sense of entrapment in responsible relationships. The authors purport that the results of this study are relevant for education and practice and can provide direction for further studies on developing theories of ethical responsibility in other nursing specialities. (shrink)

In contemporary debates in philosophy of medicine medical humanities are gaining ground in a discipline that was for many years dominated by bioethics. Phenomenology, with its focus on human experience, and a long history of interest in illness as boundary cases of human existence, turns up as a tradition with a lot to offer in this context. In their introduction to the Edinburgh Companion in Critical Medical Humanities Whitehead & Woods thus mention phenomenology as one of two key traditions within (...) what can be called second wave medical humanities (Whitehead & Woods 2016, 11). In this spirit, the collection of essays in Kevin Aho’s inspiring publication is an invitation to join the exploration of phenomenology and existential medicine and find new potentials for philosophy of medicine within these traditions. (shrink)

How philosophy is educating humanity will be explained regarding an actual example concerning the new public health paradigm or health promoting research. The central point of reference is the discussion of the decisive substantiation of the work of medical sociologist, Aaron Antonovsky; his approach to salutogenesis is opposed to the usual approach of pathogenesis. Here, emphasis is put on "Sense of Coherence". It will be shown that, in contrast to Antonovsky's original intention, the relation to the natural (...) sciences and scientific medicine is sufficient to substantiate neither his central arguments nor the relation to the continental traditions of philosophy, especially to existential philosophy and to philosophical hermeneutics mentioned in his latest works. Therefore, referring to a prominent sociological representative of modern health science, means-end rationality is no longer able to assert its dominant position in this field, but must be legitimized by value rationality. Antonovsky's concept of SoC also inevitably includes the argument that methodologically oriented explanation of health related problems can never be replaced by sense-oriented understanding. (shrink)

The COVID pandemic was an exceptional public health situation – which brought with it unprecedented restrictions across the global populace. But what was it about this pandemic which caused us to implement such drastic restrictions on liberty? Much of the ethical debate on restrictive measures such as lockdowns and vaccine requirements focused on the potential harm that individuals cause to other individuals by the risk of infection. I will suggest that this may come from a reliance on J.S. (...) Mill’s harm principle as providing the ultimate justification for coercion – i.e., the well-accepted principle that state coercion is justified in order to prevent the imposition of unacceptable risk of harm to others. Though there have been attempts, in the wider public health ethics literature, to use the harm principle as a basis for restricting contribution to collective harms, I will suggest that these attempts cannot rely on the harm principle alone. I will then turn to the ways in which an individual-based line of reasoning does not capture a distinctive sort of harm posed by the COVID pandemic (and others like it): the potential failure of healthcare systems. I will draw out three ways in which a focus on the harm that an individual poses to another individual fails to capture the full scope of harm wrought by the collapse of healthcare systems. First, it can’t adequately capture the cumulative and “looping effects” of the harm caused by strained healthcare systems. Second, it fails to capture the widespread ripple effects the failure of a central societal institution can have on other institutions. And third, the failure of a healthcare system can impose “psychic costs”, affecting the moral character of all members of society, reducing trust in institutions, and potentially posing an existential threat to the fabric of society. Finally, I will sketch some implications of the recognition of this distinctive sort of harm for the justification of coercive public health measures. (shrink)

Increasing rates of psychiatric problems like depression and anxiety among Swedish youth, predominantly among females, are considered a serious public mental health concern. Multiple studies confirm that psychological as well as existential vulnerability manifest in different ways for youths in Sweden. This multi-method study aimed at assessing existential worldview function by three factors: 1) existential worldview, 2) ontological security, and 3) self-concept, attempting to identify possible protective and risk factors for mental ill-health among female (...) youths at risk for depression and anxiety. The sample comprised ten females on the waiting list at an outpatient psychotherapy clinic for teens and young adults. Results indicated that both functional and dysfunctional factors related to mental health were present, where the quality and availability of significant interpersonal relations seemed to have an important influence. Examples of both an impaired worldview function and a lack of an operating existential worldview were found. Psychotherapeutic implications are discussed. (shrink)

Support in different modes, expressions and actions is at the core of the public welfare culture. In this paper, support is examined as an everyday interpersonal phenomenon with a variety of expressions in language and ways of relating, and its essential meaning is explored. The fulcrum for reflection is the lived experience shared by a young woman with mental health problems of her respective encounters with two professionals in mental health facilities. A phenomenological analysis of the contrasting (...) accounts suggests that, when the professional relationship includes openness and risk, a certain degree of freedom of action is possible for both parties involved in the inevitably asymmetrical relationship. Support as “given” eludes controllable and measurable objectives, but imposes itself on the lived experiences of both the giver and the receiver as subject to readiness for acceptance. By not making assumptions about what support is, we open ourselves to the possibility of reciprocally experiencing moments revealing the essential meaning of support as lived. (shrink)

What is characteristic of being aParkinson’s patient? This article intends toanswer this question by means of an analysis ofnovels about people with Parkinson’s disease,personal accounts, and scientific publications.The texts were analyzed from anexistential-phenomenological perspective, usingan adapted version of the existential analysis.Being a Parkinson’s patient is apparentlycharacterized by an existential paradox: lifeappears simultaneously immobile andunpredictably whimsical. This may manifestitself in the person’s corporeality, in hisbeing-in-time and in-space, in his relating tothings and events, his life-world, and in hisbeing-together-with-others as an (...) individual.Finally, some specific characteristics of beinga Parkinson’s patient are described that may berelevant for purposes of adequate care, as isto be specified by further research. (shrink)

ABSTRACT Recent decades have witnessed a growing interest in the topic of a meaningful life among philosophers, psychologists, and the general public. Yet despite this interest, the thinker who is perhaps most closely associated with meaning and mental health, the Austrian psychiatrist Viktor Frankl, has been largely overlooked by academic researchers. This article offers some redress to this situation by exploring the status of his central idea, the Will to Meaning, by locating it within contemporary philosophical discussions of (...) Meaning in Life, and examining the coherence of the difference elements of Frankl’s published works. A combination of biographical, historical and philosophical analysis, including reference to the thinkers who helped his ideas, such as Kierkegaard and Scheler, provides a constructively critical account of Frankl’s existential theory of meaning. It is suggested that Frankl’s theory, with amendments, provides a useful contribution to contemporary discussions in the field. (shrink)

For much of the 20th century, vulnerability to deprivations of health has often been defined by geographical and economic factors. Those in wealthy, usually ‘Northern’ and ‘Western’, parts of the world have benefited from infrastructures, and accidents of geography and climate, which insulate them from many serious threats to health. Conversely, poorer people are typically exposed to more threats to health, and have lesser access to the infrastructures needed to safeguard them against the worst consequences of such (...) exposure. However, in recent years the increasingly globalized nature of the world’s economy, society and culture, combined with anthropogenic climate change and the evolution of antibiotic resistance, has begun to shift the boundaries that previously defined the categories of person threatened by many exogenous threats to health. In doing so, these factors expose both new and forgotten similarities between persons, and highlight the need for global cooperative responses to the existential threats posed by climate change and the evolution of antimicrobial resistance. In this article, we argue that these emerging health threats, in demonstrating the similarities that exist between even distant persons, provides a catalyst for global solidarity, which justifies, and provides motivation for, the establishment of solidaristic, cooperative global health infrastructures. (shrink)

Human existence is structured as an interruption that is forever calling us into question (interrupting our everyday routinized ways of being) and confronting us with the related challenges of having a conscience, being open to and acknowledging others, striving to better ourselves when improvement is necessary for maintaining our well-being, and enacting our rhetorical competence to disclose the truth of the matters at hand.

Several Dutch politicians have recently argued that medical voluntary euthanasia laws should be extended to include healthy elderly citizens who suffer from non-medical ‘existential suffering’. In response, some seek to show that cases of medical euthanasia are morally permissible in ways that completed life euthanasia cases are not. I provide a different, societal perspective. I argue against assessing the permissibility of individual euthanasia cases in separation of their societal context and history. An appropriate justification of euthanasia needs to be (...) embedded in a wider solidaristic response to the causes of suffering. By classifying some suffering as ‘medical’ and some as ‘non-medical’, most societies currently respond to medical conditions in importantly different ways than they do to non-medical suffering. In medical cases, countries like the Netherlands have a health care, health research and public health system to systematically assign responsibilities to address causes of medical suffering. We lack such a system for non-medical suffering among elderly citizens, which makes completed life euthanasia importantly different from euthanasia in medical cases. Because of this moral ‘responsibility gap’, focusing on the permissibility of completed life euthanasia in separation of wider societal duties to attend to possible causes is societally inappropriate. To spell out this objection in more philosophical terms, I introduce the concept of acts that are morally permissible but contextually problematic. (shrink)

In Brazil, the health emergency unleashed by the Covid-19 pandemic must be understood in the context of the government administration of the former president, Jair Bolsonaro. The new coronavirus was turned into a war machine, something already seen in other moments of the history of indigenous peoples, when epidemics were strategically used to promote indigenous genocide and usurp their territories. The Sanöma, a subgroup of the Yanomami language family, assert that Covid-19 did not leave individualized traces of ‘sequelae’ but (...) made itself felt in the deaths that could not undergo the traditional funeral rites due to the sanitary measures, generating a cosmological and existential tension for the collective as a whole. It was also felt in the invasion of their lands by thousands of miners who brought violence and malaria to the communities, debilitating their food sovereignty, and in the dismantling of public health services in the indigenous land. Time was suspended, and the infection continued with the accompanying violation of rights, with a divergent understanding of who is recovered or who is healthy. This article is the result of a Covid-19 research project conducted in partnership with the Sanöma leaders. Based on reports from the Sanöma themselves, reports about the Yanomami and the government of former President Bolsonaro, interviews with indigenous leaders in newspapers and reports produced by indigenous organizations and their supporters, a set of information about Covid-19 among indigenous peoples and violations of human rights among the Sanöma people were systematized and analyzed and now make up this article. (shrink)

In this musing we consider how social distancing, the primary public health measure introduced to mitigate the spread of the COVID-19 virus, is creating social encounters characterized by a self-and-other-consciousness and an atmosphere of suspicion, leading to what we call “alienated embodied communication.” Whilst interaction rituals dominated by avoidance, fear and distrust are novel for many individuals who occupy positions of social privilege, Black and ethnic minority writers have demonstrated that the alienated bodily communication of COVID-19 social distancing (...) is “nothing new” for people who routinely experience marginalization as a result of racism. Our aim in this musing, then, is to reflect on how on-going experiences of stigma, shame, and marginalization can shape how social distancing is registered on an embodied and existential level, and therefore how social distancing may differentially impact individuals with lived experiences of racism. (shrink)

Scientists, bioethicists, and policy makers are currently engaged in a contentious debate about the scientific prospects and morality of efforts to increase human longevity. Some demographers and geneticists suggest that there is little reason to think that it will be possible to significantly extend the human lifespan. Other biodemographers and geneticists argue that there might well be increases in both life expectancy and lifespan. Bioethicists and policy makers are currently addressing many of the ethical, social, and economic issues raised by (...) life extension research. However, the emphasis on philosophical argument supporting or condemning efforts to increase human longevity means that much less attention is currently being given to the factors that might play a role in generating interest in efforts to increase human longevity. This analysis considers three factors that might play a role in heightening public interest in efforts to develop biomedical technologies capable of retarding or reversing aging processes. While discussions of life extension research can seem quite futuristic and impractical, there are some powerful existential factors that might well generate considerable public support for life extension strategies if effective biomedical interventions emerge. Rather than providing philosophical justifications supporting or condemning efforts to increase human longevity, this essay seeks to promote a better understanding of the factors generating contemporary interest in prolonging life and postponing death. (shrink)

In this paper we explore the rise of ‘the breast cancer gene’ as a field of medical, cultural and personal knowledge. We address its significance in the Norwegian public health care system in relation to so-called biological citizenship in this particular national context. One of our main findings is that, despite its claims as a measure for health and disease prevention, gaining access to medical knowledge of BRCA 1/2 breast cancer gene mutations can also produce severe instability (...) in the individuals and families affected. That is, although gene testing provides modern subjects with an opportunity to foresee their biological destiny and thereby become patients in waiting, it undoubtedly also comes with difficult existential dilemmas and choices, with implications that resonate beyond the individual and into different family and love relations. By elaborating on this finding we address the question of whether the empowerment slogan, which continues to be advocated through various health, BRCA and breast cancer discourses, reinforces a naïve or an idealized notion of the actively responsible patient: resourceful enough to seek out medical expertise and gain sufficient knowledge, on which to base informed decisions, thereby reducing the future risk of developing disease. In contrast to this ideal, our Norwegian informants tell a different story, in which there is no apparent heroic mastery of genetic fates, but rather a pragmatic attitude to dealing with a dire situation over which they have little control, despite having complied with medical advice through national guidelines and follow-up procedures for BRCA 1/2 carriers. In conclusion we claim that the sense of safety that gene testing and its associated medical solutions allegedly promise to provide proved illusory. Although BRCA-testing offers the potential for protection from adverse DNA-heritage, administered through possibilities for self-monitoring and self-management of the body, the feeling of ‘being in good health’ has hardly been reinforced by the emergence of gene technology. (shrink)

Contemporary approaches to the study of suicide tend to examine suicide as a medical or public health problem rather than a moral problem, avoiding the kinds of judgements that have historically characterised discussions of the phenomenon. But morality entails more than judgement about action or behaviour, and our understanding of suicide can be enhanced by attending to its cultural, social, and linguistic connotations. In this work, I offer a theoretical reconstruction of suicide as a form of moral experience (...) that delineates five distinct, yet interrelated domains of understanding: the temporal, the relational, the existential, the ontological, and the linguistic. Attention to each of these domains, I argue, not only enriches our understanding of the moral realm but also provides a heuristic for examining the moral traditions and practices that constitute contemporary understandings of suicide. (shrink)

The contributions of Professor Bernard Dickens to health law and bioethics span the era in which these fields have emerged as distinct domains of teaching, scholarship and professional and public conversation. Neither field exists in a vacuum. The concerns of bioethics, like the content of health law, are a product of social forces. The bureaucratization of medical care, the possibilities and uncertainties created by developments in medical technology, not to mention glaring health inequalities, have been destabilizing (...) forces in medicine. Writing in 1974, American sociologist Renée Fox noted that medicine had reached “a stage of development characterized by diffuse ethical and existential self-consciousness.” This new medical introspection was evidenced by intense engagement with issues of biomedical regulation, and with the growth of professional codes and processes for resolving value-laden issues within clinical settings.While sometimes described as a process or site for discussion and “engagement,” bioethics evolved rapidly into a domain of governance, with direct implications for clinical practice. (shrink)

This paper is a philosophical inquiry about the state of man during the pandemic. By philosophy, I mean a rational investigation of profound and critical questions that seeks to address fundamental issues pertaining to the meaning of life. This study attempts to understand how the sovereign rule of the state is controlling the population in the midst of the coronavirus crisis. It argues that political power, through fear, has isolated human beings away from each other in the name of (...) class='Hi'>public health protocols. State power plays on the vulnerabilities of the people to take advantage of the situation. The state apparatus is exercising full and unprecedented disciplinary measures as an extreme form of bio-power purportedly meant to mitigate the crisis. However, what is not seen is the reality that unjust structures and the unequal situations of individuals in human society have resulted to more hardships on the part of the poor, thereby diminishing their sense of self-worth. The most profound question when it comes to the pandemic, this paper argues, is existential – the reality of death. (shrink)

This paper explores some of the reasons why we, as a business ethics center housed at a state university, are transitioning from being a largely neutral platform on business ethics topics to becoming an advocate for specific perspectives. Comprising the topics of interest are issues such as climate change, capitalism, and certain medical and public health controversies. Presented here are four main reasons behind this move: pluralistic arguments, moral “switching,” existential crises, and combating disinformation. Two examples regarding (...) capitalism and vaccine mandates are used to demonstrate advocacy in practice. (shrink)

This book presents the case for Compassionate Reasoning as a moral and psychosocial skill for the positive transformation of individuals and societies. It has been developed from a reservoir of moral philosophical, cultural, and religious wisdom traditions over the centuries. These have been derived from a careful combination of classical schools of ethical thought that are artfully combined with compassion neuroscience, contemporary approaches to conflict resolution, public health methodologies, and positive psychological approaches to social change. There is an (...) urgent need for human civilization to invest in the broad-based cultivation of compassionate thoughts, feelings, and especially habits. This skill is then combined with moral reasoning to move the self and others toward less anger and fear, more joy and care in the pursuit of reasonable policies that build peaceful families, communities, and societies. There are many people across the planet who work every day for the sake of others but who are ensconced in exhausting work with dangerous and difficult situations of conflict. These people are often heroic bridge-builders and creators of peaceful societies, and they have a common set of cultivated moral character traits and psychosocial skills. They tend to be kinder, more reasonable, more self-controlled, and more goal-oriented to peace. They are united by a particular set of moral values and the emotional skills to put those values into practice. The aim of this book is to articulate the best combination of those values and skills that lead to personal and communal sustainability, not burnout and self-destruction. The book pivots on the observable difference in the mind-and proven in neuroscience imaging experiments-between destructive empathic distress, on the one hand, and, on the other, joyful, constructive, compassionate care. Facing existential threats to life on the planet, humans can and must make such skills universally sustainable and ingrained. (shrink)

Pioneering researchers claim that telepsychiatry presents the possibility of improving both the quality and quantity of patient care for populations in general as well as for those in rural and remote locations. The prevalence of, and literature on telepsychiatry has increased dramatically in the last decade, covering all aspects of research endeavors. However, little can be found on the topic of ethics in telepsychiatry. Using various clinical scenarios we may provide insight into the moral challenge in telepsychiatry—the lack of in-person (...) contact. The difficulty is to articulate what the significance of in-person contact is and further, its meaning in the therapeutic relationship between the patient and the physician. Using the personalist perspective and related philosophical approaches we may sketch an idea of the patient as person, existentially considered as a relational and bodily human being. By applying Brennan’s model for health technology assessment we may evaluate the morally troubling aspect of telepsychiatry—a lack of in-person contact—on this philosophical sketch of the person. This consideration is crucial when developing policies to guide the use of telepsychiatry in order to maintain the quality of care. (shrink)

Agoraphobia is commonly considered to be a fear of outside, open, or crowded spaces, and is treated with therapies that work on acclimating the agoraphobic to external places she would otherwise avoid. I argue, however, that existential phenomenology provides the resources for an alternative interpretation and treatment of agoraphobia that locates the problem of the disorder not in something lying beyond home, but rather in a flawed relationship with home itself. More specifically, I demonstrate that agoraphobia is the lived (...) body expression of a person who has developed an inward-turning tendency with respect to being-at-home, and who finds herself, as a result, vulnerable and even incapacitated when attempting to emerge into the public arena as a fully participatory agent. I consider this thesis in light of the fact that since World War I agoraphobia has been diagnosed significantly more in women than in men; indeed, one study found women to be 89% more likely than men to suffer from agoraphobia. I conclude that agoraphobia is a disorder that stands as an emblematic expression of the ongoing pathology of being a woman in contemporary society–a disorder that reflects that even today women belong to a political world in which they are not able to feel properly at-home. (shrink)

This article poses an invitation for bioethicists to engage with loneliness as a bioethics and public health concern. I argue that loneliness is a relevant issue for bioethicists for three main reasons: it causes ill‐health; particularly in the age of Covid‐19, it is becoming prominent on the clinical and public health agenda, affecting millions worldwide; and it engenders several ethical and philosophical questions as a social determinant of health with a rich conceptual background. In (...) what follows I first review the link between loneliness and ill‐health and argue that it should concern bioethicists because of this link. I also demonstrate how pertinent the issue of loneliness is being considered nowadays, and mark this as another reason for bioethicists to become engaged. I then move on to define loneliness and its various forms, drawing from modern and contemporary philosophers. The way we choose to cope with the pandemic of loneliness depends in part on its theoretical underpinnings, as well as its empirical scope. Theory thus combines with empirical data in order to devise and implement a rational public health policy, necessitating the kind of interdisciplinary approach that is the bedrock of bioethics. I conclude by suggesting future areas of research and recommendations. (shrink)

In bioethics, discussions of justice have tended to focus on questions of fairness in access to health care: is there a right to medical treatment, and how should priorities be set when medical resources are scarce. But health care is only one of many factors that determine the extent to which people live healthy lives, and fairness is not the only consideration in determining whether a health policy is just. In this pathbreaking book, senior bioethicists Powers and (...) Faden confront foundational issues about health and justice. How much inequality in health can a just society tolerate. The audience for the book is scholars and students of bioethics and moral and political philosophy, as well as anyone interested in public health and health policy. (shrink)

This book fills a gap in the literature on the Precautionary Principle by placing the principle within the wider context of precautionary reasoning and uses philosophical arguments and case studies to demonstrate when it does—and does not—apply. The book invites the reader to take a step back from the controversy surrounding the Precautionary Principle and consider the overarching rationales for responding to threats to the environment or public health. It provides practical guidance and probing insight for the intended (...) audience, including scholars, students, journalists, and policymakers. (shrink)

During times of crisis, institutions tend to focus on maintaining or restoring public trust, as well as on measures to insulate themselves (and their leadership) from potential legal liability. This is because institutions reflexively turn to lawyers, risk managers, crisis consultants, and public relations firms that focus on what they euphemistically call the “optics.” In this essay, I highlight the vital importance of addressing underlying reasons for an institution's loss of public trust—in particular, the loss (or erosion) (...) of its integrity and trustworthiness. Loss of public trust generates one kind of crisis—which I term “opsis.” But there is another kind of institutional crisis that so often remains unrecognized. Just as medical sepsis in the human body is a critical condition that endangers life, the loss of an institution's integrity and trustworthiness constitutes a type of sepsis—ethical sepsis—that poses an existential threat to the institution if unaddressed. (shrink)

John Coggon argues that the important question for analysts in the fields of public health law and ethics is 'what makes health public?' He offers a conceptual and analytic scrutiny of the salient issues raised by this question, outlines the concepts entailed in, or denoted by, the term 'public health' and argues why and how normative analyses in public health are inquiries in political theory. The arguments expose and explain the political claims (...) inherent in key works in public health ethics. Coggon then develops and defends a particular understanding of political liberalism, describing its implications for critical study of public health policies and practices. Covering important works from legal, moral, and political theory, public health, public health law and ethics, and bioethics, this is a foundational text for scholars, practitioners and policy bodies interested in freedoms, rights and responsibilities relating to health. (shrink)

Since the 1970s, prenatal testing has been integrated into many health care systems on the basis of two competing and largely irreconcilable rationales. The reproductive autonomy rationale focuses on nondirective counseling and consent as ways to ensure that women's decisions about testing and subsequent care are informed and free of undue pressures. It also represents an easily understandable and ethically convincing basis for widespread access to prenatal testing, since the value of autonomy is well established in Western bioethics and (...) widely recognized by funders of health care. In contrast, the public health rationale approaches prenatal testing as designed to reduce the incidence of certain conditions in the population to reduce the burden of disease. This rationale emphasizes the societal consequences of reproduction and the aggregate impact of women's individual reproductive decisions on the overall health of future populations. In this essay, I argue that, despite what could be seen as a persistent failure to meet the ideals of reproductive autonomy, resisting the public health rationale as a basis for prenatal screening is ethically and pragmatically crucial. I recommend policy mechanisms that can enhance reproductive autonomy at a societal level to support choice at the individual level. (shrink)

This book offers a novel critique of public-private partnerships in public health. The author argues these relationships create webs of influence that undermine the integrity of public health agencies, and imperil public health. He makes a compelling case that the paradigm interaction between governments and corporations should be at arm's length: separation, not collaboration.

It is perhaps most useful to approach the Doctor-Patient relationship (DPR) by admitting that it’s complicated. We review some of the strategies that have been employed to mitigate this complexity, zeroing in on one that promises to capture the main features of the DPR without eliminating some of its more important, existential components; pieces of the puzzle that must be retained if we are to avoid oversimplification and the errors that can arise by ignoring important foundational properties. We believe (...) that a useful way to look at the DPR and to capture essential features that must be balanced in the process is provided by Partnership Theory and its definition in terms of the so-called domination and partnership systems. We apply this theory to the DPR and investigate the implications of this application to health care. We see that in the absence of mitigating circumstances, adoption of the patient-as-partner model serves healthcare well and is flexible enough to accommodate circumstances that dictate modifications. (shrink)

One of most pertinent and acute risks that the world is now facing is emerging or re-emerging zoonotic diseases. This article focuses on culling as a measure for zoonotic disease control, specifically the culling of 11,000 badgers as part of the Randomized Badger Culling Trial in the UK and the culling exercises in Singapore. The independent expert panel that devised the UK study concluded that reactive culling was ineffective in reducing the cases of bovine tuberculosis in cattle. The panel also (...) concluded that proactive culling was not cost-effective. Behind the scarcity of empirical evidence to support culling, the resultant reduction in biodiversity can actually harm both animals and humans. Public health policies should be evidence-based, culturally adaptable and ethically justified; a novel biomedical and public health approach, named One Health, plausibly provides a reasonable ethical framework as well as research and interventional methods that square with that framework. OH recognizes that nonhuman animals and humans are interlinked in both sickness and health, since we all share the same ecosystem. OH could potentially replace standard public health strategies, as it provides alternative evidence-based methods for biomedical research and adds a non-anthropocentric component to an ethical decision-making process. (shrink)

Comprehensive Biomedical Research Centre and Centre for Philosophy, Justice and Health, UCL, First Floor, Charles Bell House, 67–73 Riding House Street, London W1W 7EJ, UK. Tel.: +44 (0)20 7679 9417; Fax: +44 (0)20 7679 9426; Email: james-gs.wilson{at}ucl.ac.uk ' + u + '@' + d + ' '//--> . Abstract This paper aims to shed some light on the difficulties we face in constructing a generally acceptable normative framework for thinking about public health. It argues that there are (...) three factors that combine to make theorising about public health difficult, and which when taken together defeat simplistic top-down and bottom-up approaches to the design of public health policies. The first factor is the problem of complex systems, namely that the distribution of health both affects and is affected by the distribution of other goods. The second is the difficulty of defining the goals of public health: we still need to get clear about what we should mean by health in this context, and what the goals of public health should be. The third is that we stand in need of an account of how important health is relative to the importance of other goods that a just society should be trying to secure for its citizens. The paper argues that these problems should lead us to abandon the search for a ‘one-size fits all’ normative framework for thinking about public health. Rather, different approaches will be appropriate at different levels of abstraction. CiteULike Connotea Del.icio.us What's this? (shrink)

Centre for Applied Philosophy and Public Ethics, The Australian National University, LPO Box 8260, ANU, Canberra ACT 2601, Australia. Email: michael.selgelid{at}anu.edu.au ' + u + '@ ' + d + ' '/ /- ->. Home page: http: //www.cappe.edu.au/staff/michael-selgelid.htmThis article advocates the development of a moderate pluralist theory of political philosophy that recognizes that utility, liberty and equality are legitimate, independent social values and that none should have absolute priority over the others. Inter alia, such a theory would provide a (...) principled means for striking a balance, or making trade-offs, between these values in cases of conflict. Recent developments in public health ethics have made progress in thinking about how to make trade-offs between liberty and utility in particular. While public health ethicists often claim that the least restrictive alternative should be used to achieve the public health goal in question, I argue that a plausible but under-recognized idea is that the least restrictive alternative might sometimes involve improvement of global health via redistributive taxation—i.e., rather than coercive social distancing measures. I conclude by demonstrating that the proportionality principle leaves open the question of when exactly utility outweighs liberty or vice versa—and I argue that, rather than speaking about the morality of liberty-infringing public health interventions in categorical/binary terms, it would be more fruitful and realistic to think and speak about the degree to which a liberty-infringing public health intervention is morally appropriate. CiteULike Connotea Del.icio.us What's this? (shrink)

Social theory is developing in response to the coronavirus (COVID) crisis. Fundamental questions about social justice in the relationship of individuals to society are raised by Delanty in his review of political philosophy, including Agamben, Foucault and Žižek. However, the focus on the libertarian critique of authoritarianism is not enough. The social democratic critique of neoliberalism lies at the centre of the contesting responses to the COVID crisis. A social democratic perspective on public health, democracy and state action (...) is contrasted with the anti-statists of left and right. This is addressed in debates on the relationship between science and governance, the place of crisis in theories of change and the conceptualisation of alternative forms of social formation. The crisis initiated by the pandemic, cascading through society, from health to economy, to polity and into violence, includes a contestation between social democratic and neoliberal visions of alternative forms of society. (shrink)

Attention to individual choice is a valuable dimension of public health policy; however, the creation of effective public health programmes requires policy makers to address the material and social structures that determine a person’s chance of actually achieving a good state of health. This statement summarizes a well understood and widely held view within public health practice. In this article, we (i) argue that advocates for public health can and should defend (...) this emphasis on ‘structures’ by reference to citizen autonomy and not simply by emphasizing concern for counter-balancing values such as ‘population health’ or ‘fairness’, (ii) map and critically explore the contrasting conceptions of autonomy that feature in such debates, with particular attention to conceptions of autonomy that might feature in the defence of an emphasis on structures. We draw on (i) a relational conception of autonomy and (ii) the distinction that can be made between autonomous deliberation and autonomous action to suggest that offering people the opportunity to make choices about their health without also supporting their capability to achieve the object of these choices falls short of what is often considered to be morally and politically important about promoting autonomy in relation to health. (shrink)

Racism is a key driver of the social, political, and economic injustices that cause and maintain health inequities. Over centuries and across continents, racism has become deeply ingrained within societies. Therefore, we believe that it is our professional and ethical obligation as scientists, and public health scholars specifically, to address racism head on in order to ameliorate racialized health disparities. We argue that greater focus is needed on addressing racism rather than race and how race is (...) described or defined. We offer input from public health scholarship to help bioethicists and other scientists contribute to addressing racism. To do so effectively and comprehensively, public health scholars, bioethicists, and other scientists should work together to identify and implement equity-driven collaborations to eliminate the deleterious effects of racism on individuals, families, and communities. (shrink)

The intervention ladder, developed by the Nuffield Council on Bioethics, is a framework intended to help evaluate the ethical acceptability and justification of public health interventions according to their intrusion on liberty.1 In their recent article, Paetkau2 argues ‘the ladder obscures potential interventions that operate on a systemic rather than individual level’ (p. 1) and that ‘it is crucial that systemic interventions not be left off the table when considering potential concrete interventions’ (p. 3), leading them to propose (...) instead the ‘intervention stairway’. Yet, in this commentary we argue the intervention ladder does not delimit the sorts of public health interventions that may be considered to address a public health issue, although it may speak to their putative justification. Hence, despite its other considerable shortcomings,3 4 there is no need, as Paetkau argues, to broaden the intervention ladder to include systemic factors. Contrary to Paetkau’s claim, the intervention ladder does not preclude policymakers from considering systemic factors’ impact on health outcomes or the public health interventions and strategies that could be implemented to address them. Paetkau adduces the example of measures to protect patients, healthcare workers and healthcare capacity from the threat of infectious diseases. They argue that certain …. (shrink)

Neuropsychiatric disorders such as drug addiction, depression and schizophrenia are often centrally implicated in public health challenges. These conditions impact the individuals affected and have widespread implications, contributing to related crises such as opioid epidemic, rising suicide rates and homelessness. Despite their influence, public health interventions frequently emphasise individual responsibility, overlooking the complex interplay of neurobiological and systemic factors that underpin these disorders. Current public health frameworks, such as the Nuffield Council on Bioethics’ intervention (...) ladder, prioritise efforts that encourage individual behaviour change. Paetkau critiques this emphasis on individual responsibility, emphasising the need to consider more systemic factors, such as social determinants of health, as targets of necessary intervention.1 We aim to reinforce Paetkau’s critique of the intervention ladder by introducing three neuropsychiatric case studies, each highlighting the limitations of an individual-based framework in addressing psychopathology-involved public health issues. We argue that conditions like addiction, depression and serious mental illness undermine the emphasis on individual responsibility in public health and policy interventions. To this end, neuroscience demonstrates that effective public health interventions necessitate a shift from the long-standing emphasis on individual responsibility towards more comprehensive, systems-level interventions. Opioid overdose deaths in the USA have sextupled since 1999, with over 100,000 deaths in 2023 alone.2 The opioid crisis has since remained one of the most pressing public …. (shrink)

Background Bioethical debates about privacy, big data, and public health surveillance have not sufficiently engaged the perspectives of those being surveilled. The data justice framework suggests that big data applications have the potential to create disproportionate harm for socially marginalized groups. Using examples from our research on HIV surveillance for individuals incarcerated in jails, we analyze ethical issues in deploying big data in public health surveillance. -/- Methods We conducted qualitative, semi-structured interviews with 24 people living (...) with HIV who had been previously incarcerated in county jails about their perspectives on and experiences with HIV surveillance, as part of a larger study to characterize ethical considerations in leveraging big data techniques to enhance continuity of care for incarcerated people living with HIV. -/- Results Most participants expressed support for the state health department tracking HIV testing results and viral load data. Several viewed HIV surveillance as a violation of privacy, and several had actively avoided contact from state public health outreach workers. Participants were most likely to express reservations about surveillance when they viewed the state’s motives as self-interested. Perspectives highlight the mistrust that structurally vulnerable people may have in the state’s capacity to act as an agent of welfare. Findings suggest that adopting a nuanced, context-sensitive view on surveillance is essential. -/- Conclusions Establishing trustworthiness through interpersonal interactions with public health personnel is important to reversing historical legacies of harm to racial minorities and structurally vulnerable groups. Empowering stakeholders to participate in the design and implementation of data infrastructure and governance is critical for advancing a data justice agenda, and can offset privacy concerns. The next steps in advancing the data justice framework in public health surveillance will be to innovate ways to represent the voices of structurally vulnerable groups in the design and governance of big data initiatives. (shrink)

How far should we go in protecting and promoting public health? Can we force people to give up unhealthy habits and make healthier choices, or does everyone have the right to decide their own lifestyle? Should we stop treating smokers who refuse to give up smoking? Should we put a tax on fatty foods and ban vending machines in schools to address the obesity epidemic? Should parents be required to have their children vaccinated? Are some of our screening (...) programmes unethical Downs syndrome screening, for example or should we be screening people for more conditions, such as Huntington disease? Such questions are at the heart of public health ethics. Holland shows that to understand and debate these issues requires philosophy: moral philosophies, such as utilitarianism and deontology, as well as political philosophies such as liberalism and communitarianism. And philosophy informs other aspects of public health, such as epidemiology and health promotion. The aim of this book is to provide a lively, accessible and philosophically informed introduction to such issues. It is an ideal textbook for students taking courses in public health ethics. And since this book develops systematic discussions of issues in public health ethics, there is also much here to engage and challenge the more advanced reader. (shrink)

In June 2012, New York City Mayor Michael Bloomberg announced his plans for a ban on the sale of sugary beverages in containers larger than 16 ounces. Shortly thereafter, the Center for Consumer Freedom took out a full-page ad in the New York Times featuring Bloomberg photo-shopped into a matronly dress with the tag line “New Yorkers need a Mayor, not a Nanny.” On television, the CATO Institute's Michael Cannon declared, “This is the most ridiculous sort of nanny state-ism; [i]t’s (...) none of the mayor's business how much soda people are drinking.” And in newspapers around the country, editorial pages featured headlines such as “Gulp! Yet Another Intrusion of the Nanny State.” Just like that, the public debate about this measure became focused on government overreach, while the public health problem of obesity faded into the background. (shrink)

This article draws on scientific explanations of obesity to motivate the creation of a system of paternalistic public health interventions into the obesity epidemic. Libertarian paternalists argue that paternalism is warranted in light of the cognitive limits of human decision-making abilities. There are further, specific biological limits on our capacity to choose and maintain a healthy diet. These biological facts strengthen the general motivation for libertarian paternalism. As a consequence, the creation of a system of paternalistic public (...) health interventions into the obesity epidemic is warranted. (shrink)

ABSTRACT Data from digital technologies are increasingly integrated in public health research. In April of 2020, we interviewed a subset of participants who completed a survey approximately one month earlier. Using the survey, we contacted and interviewed participants who had expressed their willingness or unwillingness to share digital data for use in public health. We followed a directed content analysis approach for the analysis of the interview data. Among participants who had reported being unwilling to share (...) data, concerns about privacy, confidentiality, and the purpose of the research were cited. During the interviews, 76.9% of the participants who had who had previously indicated that they were unwilling to share their data, expressed willingness to share data in order to assist with COVID-19 prevention. Our results contribute to our understanding of people’s perspectives on sharing personal data and of the way their perspectives can vary as a function of potential uses of their personal information. (shrink)

Between 2013 and 2016, West Africa experienced the largest ever outbreak of Ebola Virus Disease. In the absence of registered treatments or vaccines to control this lethal disease, the World Health Organization coordinated and supported research to expedite identification of interventions that could control the outbreak and improve future control efforts. Consequently, the World Health Organization Research Ethics Review Committee was heavily involved in reviews and ethics discussions. It reviewed 24 new and 22 amended protocols for research studies (...) including interventional and observational studies. WHO-ERC provided the reviews within on average 6 working days. The WHO-ERC often could not provide immediate approval of protocols for reasons which were not Ebola Virus Disease specific but related to protocol inconsistencies, missing information and complex informed consents. WHO-ERC considerations on Ebola Virus Disease specific issues are presented. To accelerate study approval in future public health emergencies, we recommend: internally consistent and complete submissions with information documents in language participants are likely to understand, close collaboration between local and international researchers from research inception, generation of template agreements for data and sample sharing and use during the ongoing global consultations on bio-banks, formation of Joint Scientific Advisory and Data Safety Review Committees for all studies linked to a particular intervention or group of interventions, formation of a Joint Ethics Review Committee with representatives of the Ethics Committees of all institutions and countries involved to strengthen reviews through the different perspectives provided without the ‘opportunity costs’ for time to final approval of multiple, independent reviews, direct information exchange between the chairs of advisory, safety review and ethics committees, more Ethics Committee support for investigators than is standard and a global consultation on criteria for inclusion of pregnant women and children in interventional studies for conditions which put them at particularly high risk of mortality or other irreversible adverse outcomes under standard-of-care. (shrink)

In their recent article, Brownet alanalyse several ethical aspects around immunity passports and put forward some recommendations for implementing them. Although they offer a comprehensive perspective, they overlook two essential aspects. First, while the authors consider the possibility that immunological passports may appear to discriminate against those who do not possess them, the opposite viewpoint of immune people is underdeveloped. We argue that if a person has been tested positive for and recovered from COVID-19, becoming immune to it, she cannot (...) be considered a hazard to public health and, therefore, the curtailment of her fundamental rights (eg, the right to freedom of movement) is not legitimate. Second, they omit that vaccine distribution will create similar problems related to immunity-based licenses. Vaccine certificates will de facto generate a sort of immunity passport. In the next phases of the pandemic, different immunity statuses will be at stake, because the need to identify who can spread COVID-19 is unavoidable. If a person does not pose a threat to public health because she cannot spread the infection, then her right to freedom of movement should be respected, regardless of how she acquired that immunity. (shrink)

Public protest continued to represent a prominent form of social activism in democratic societies during the COVID-19 pandemic. In Australia, a lack of specific legislation articulating protest rights has meant that, in the context of pandemic restrictions, such events have been treated as illegal mass gatherings. Numerous large protests in major cities have, indeed, stirred significant public debate regarding rights of assembly during COVID-19 outbreaks. The ethics of infringing on protest rights continues to be controversial, with opinion divided (...) as to whether public health goals or human rights should take precedence. This paper applies public health ethical theory to an in-depth analysis of arguments on both sides of the debate. Using the Nuffield Council on Bioethics framework as a backdrop, proportionality and necessity of restrictions are understood as key concepts that are common to both public health and human rights perspectives. The analysis presented here finds a middle-ground between the prevailing arguments on opposing sides and is further able to rationalize the use of protest itself as an important element of a mature public health ethics response to restrictive policy. Thus, this paper aims to influence public health policy and legislation regarding protest rights during public health emergencies. (shrink)

There are a number of important links and similarities between public health and safety. In this extended essay, Gregg D. Caruso defends and expands his public health-quarantine model, which is a non-retributive alternative for addressing criminal behavior that draws on the public health framework and prioritizes prevention and social justice. In developing his account, he explores the relationship between public health and safety, focusing on how social inequalities and systemic injustices affect (...) class='Hi'>health outcomes and crime rates, how poverty affects brain development, how offenders often have pre-existing medical conditions (especially mental health issues), how involvement in the criminal justice system itself can lead to or worsen health and cognitive problems, how treatment and rehabilitation methods can best be employed to reduce recidivism and reintegrate offenders back into society, and how a public health approach could be successfully applied within the criminal justice system. Caruso's approach draws on research from the health sciences, social sciences, public policy, law, psychiatry, medical ethics, neuroscience, and philosophy, and he delivers a set of ethically defensible and practically workable proposals for implementing the public health-quarantine model. The essay begins by discussing recent empirical findings in psychology, neuroscience, and the social sciences that provide us with an increased understanding of the social and neurological determinants of health and criminal behavior. It then turns to Caruso's public health-quarantine model and argues that the model provides the most justified, humane, and effective approach for addressing criminal behavior. Caruso concludes by proposing a capability approach to social justice grounded in six key features of human well-being. He argues that we cannot successfully address concerns over public health and safety without simultaneously addressing issues of social justice—including the social determinants of health (SDH) and the social determinants of criminal behavior (SDCB)—and he recommends eight general policy proposals consistent with his model. (shrink)