The purpose of the study is to observe the impact of policy intervention on financial sustainability using the structural vector autoregression analysis. The population of the study is the manufacturing sector of Pakistan, which is an emerging economy. Data for 249 firms operating in the manufacturing sector are taken, collected from Datastream from 2005 to 2019, with total observations of 2,400. To conduct the analysis, R software is used for its better visualization. Results show that firm performance, corporate governance, (...) and sectoral policies have a positive and long-term impact on financial sustainability, whereas earning management and financialization not only have a negative impact, but this impact affects the operations of the corporate for a longer period. This study would be helpful for policymakers as it gives a framework for financial sustainability based on the policies and strategies developed by the sector. (shrink)

Measured against the gloomy pre-COVID-19 predictions, Africa has fared far better than most regions in managing the pandemic. This much, however, has received less attention. This paper answers the question: how have the new rituals of self determination in public health affected the successful management of COVID-19 in Africa, and how can the continent and the rest of the world build on such models/lessons in the post-pandemic era? I employ emancipatory theorising in reviewing literature on approaches to governance of COVID-19. (...) The rationale is to empower the grassroots and to accentuate the urgency for a decolonized local ownership of the governance of all public health crises. I argue that while traditional international cooperation is necessary for additional resource and expertise from the global North for sustainable health, the political will of Southern governments remains fundamental for any extraordinary success due to its grassroots/community orientation towards non-pharmaceutical interventions and initial pre-emptive rituals. The novelty in this paper is that it lays bare the ignored African responses and lessons and reveals how to harness protective communitarian ethos in solving future crises. The paper further provides population health as an ‘immune system’ policy framework for explaining and predicting how a scientific and human-centrered grassroots leadership can yield optimal outcomes in any future crisis. (shrink)

To contribute to a better understanding of the determinants of climate-friendly organizational behavior, we study the potential of behavioral policy interventions and social norms to foster individual contributions to organizational decarbonization initiatives. We investigate the effects of different types of behavioral policy interventions (default nudges vs. short-term boosts) in isolation and when they are combined with normative appeals to adopt climate-friendly behaviors in an organizational context. In a 2 × 2 between-subjects experiment, we find that default (...) nudges generally induced higher individual contributions to organizational carbon compensation programs than short-term boosts. Moreover, injunctive social norm information decreased the effectiveness of both types of behavioral interventions but affected the effectiveness of short-term boosts to a stronger extent than the effectiveness of default nudges. Contributing to the nascent literature on motivating climate change mitigating behaviors in organizational contexts, we additionally explore whether factors such as personality traits, pro-social and pro-environmental beliefs, attitudes, and behaviors, and the degree of organizational identification exert an influence on the effectiveness of the interventions and provide qualitative insights into participants’ reasoning for their decisions. (shrink)

The ethics of the Flexibility In duty hour Requirements for Surgical Trainees trial have been vehemently debated. Views on the ethics of the FIRST trial range from it being completely unethical to wholly unproblematic. The FIRST trial illustrates the complex ethical challenges posed by cluster randomised trials of policy interventions involving healthcare professionals. In what follows, we have three objectives. First, we critically review the FIRST trial controversy, finding that commentators have failed to sufficiently identify and address many (...) of the relevant ethical issues. The 2012 Ottawa Statement on the Ethical Design and Conduct of Cluster Randomized Trials provides researchers and research ethics committees with specific guidance for the ethical design and conduct of CRTs. Second, we aim to demonstrate how the Ottawa Statement provides much-needed clarity to the ethical issues in the FIRST trial, including: research participant identification; consent requirements; gatekeeper roles; benefit-harm analysis and identification of vulnerable participants. We nonetheless also find that the FIRST trial raises ethical issues not adequately addressed by the Ottawa Statement. Hence, third and finally, we raise important questions requiring further ethical analysis and guidance, including: Does clinical equipoise apply to policy interventions with little or no evidence-base? Do healthcare providers have an obligation to participate in research? Does the power-differential in certain healthcare settings render healthcare providers vulnerable to duress and coercion to participant in research? If so, what safeguards might be implemented to protect providers, while allowing important research to proceed? (shrink)

This paper explores the analytical relevance of Foucault's notion of biopower in the context of regulating and managing non-human lives and populations, specifically those animals that are the focus of livestock breeding based on genetic techniques. The concept of biopower is seen as offering theoretical possibilities precisely because it is concerned with the regulation of life and of populations. The paper approaches the task of testing the 'analytic mettle' of biopower through an analysis of four policy documents concerned with (...) farm animal genetics: the UK's National Scrapie Plan (2003); the UK National Action Plan on Farm Animal Genetic Resources (2006); the Agriculture and Environment Biotechnology Committee's report on Animals and Biotechnology (2002); and the Farm Animal Welfare Council's report on the Welfare Implications of Animal Breeding and Breeding Technologies in Commercial Agriculture (2004). Of interest is whether and how the four policy case studies articulate a form of biopower in relation to human-livestock animal relations in the context of genetic approaches to livestock breeding, and how biopower is variably expressed in relation to the different policy issues addressed. In concluding, the paper considers the overall applicability and relevance of biopower in the context of regulating animal lives within livestock breeding, highlighting both possibilities and limitations, and offers suggestions for taking forward research on livestock populations from a neo-Foucaultian perspective. (shrink)

This symposium of the Journal of Bioethical Inquiry illustrates structural competency: how clinical practitioners can intervene on social and institutional determinants of health. It will require training clinicians to see and act on structural barriers to health, to adapt imaginative structural approaches from fields outside of medicine, and to collaborate with disciplines and institutions outside of medicine. Case studies of effective work on all of these levels are presented in this volume. The contributors exemplify structural competency from many angles, from (...) the implications of epigenetics for environmental intervention in personalized medicine to the ways clinicians can act on fundamental causes of disease, address abuses of power in clinical training, racially desegregate cities to reduce health disparities, address the systemic causes of torture by police, and implement harm-reduction programs for addiction in the face of punitive drug laws. Together, these contributors demonstrate the unique roles that clinicians can play in breaking systemic barriers to health and the benefit to the U.S. healthcare system of adopting innovations from outside of the United States and outside of clinical medicine. (shrink)

Scholars have proposed that incarceration rates might be reduced by a requirement that judges justify incarceration decisions with respect to their operational costs (e.g., prison capacity). In an Internet-based vignette experiment (N = 214), we tested this prediction by examining whether criminal punishment judgments (prison vs. probation) among university undergraduates would be influenced by a prompt to provide a justification for one's judgment, and by a brief message describing prison capacity costs. We found that (1) the justification prompt alone was (...) sufficient to reduce incarceration rates, (2) the prison capacity message also independently reduced incarceration rates, and (3) incarceration rates were most strongly reduced (by about 25%) when decision makers were asked to justify their sentences with respect to the expected capacity costs. These effects survived a test of robustness and occurred regardless of whether participants reported that prison costs should influence judgments of incarceration. At the individual crime level, the least serious crimes were most amenable to reconsideration for probation. These findings are important for policymakers attempting to manage high incarceration rates. (shrink)

Contemporary food supply chains are generating externalities with high economic and social costs, notably in public health terms through the rise in diet-related non-communicable disease. The UK State is developing policy strategies to tackle these public health problems alongside intergovernmental responses. However, the governance of food supply chains is conducted by, and across, both private and public spheres and within a multilevel framework. The realities of contemporary food governance are that private interests are key drivers of food supply chains (...) and have institutionalized a great deal of standards-setting and quality, notably from their locations in the downstream and midstream sectors. The UK State is designing some downstream and some midstream interventions to ameliorate the public health impacts of current food consumption patterns in England. The UK State has not addressed upstream interventions towards public health diet at the primary food production and processing stages, although traditionally it has shaped agricultural policy. Within the realities of contemporary multilevel governance, the UK State must act within the contexts set by the international regimes of the Common Agricultural Policy and the World Trade Organization agreements, notably on agriculture. The potential for further upstream agricultural policy reform is considered as part of a wider policy approach to address the public health externalities issuing from contemporary food supply chains within this multilevel governance context. (shrink)

This chapter considers how one should frame and deal with the policy decisions that are raised by the prospect of a new generation of technologies with enhanced capabilities for changing and extending the normal human lifespan. The focus on policy decisions is intended to emphasize a contrast with a related set of questions about the desirability of what we stand to gain as individuals by an enhanced capability to intervene in the aging process. The chapter discusses the following (...) questions: Should public funds be committed to support the development or use of this capability to intervene in the aging process in humans? Should legal restraints be imposed on private attempts to develop or use such a capability? The chapter considers the fairness of allowing some individuals to purchase for themselves technologies that could substantially extend their lifespan if it is decided not to make public funds available for this purpose. (shrink)

Early intervention aims to identify children or families at risk of poor health, and take preventative measures at an early stage, when intervention is more likely to succeed. EI is concerned with the just distribution of “life chances,” so that all children are given fair opportunity to realize their potential and lead a good life; EI policy design, therefore, invokes ethical questions about the balance of responsibilities between the state, society, and individuals in addressing inequalities. We analyze a corpus (...) of EI policy guidance to investigate explicit and implicit ethical arguments about who should be held morally responsible for safeguarding child health and well-being. We examine the implications of these claims and explore what it would mean to put the proposed policies into practice. We conclude with some remarks about the useful role that philosophical analysis can play in EI policy development. (shrink)

Gerald Dworkin provides an insightful starting point for determining acceptable paternalism through his commitment to protecting our future autonomy and health from lasting damage. Dworkin grounds his argument in an appeal to inherent goods, which this paper argues is best considered as a commitment to human flourishing. However, socialconnectedness is also fundamental to human flourishing and an important consideration when determining the just limits of paternalistic drug controls, a point missing from Dworkin’ essay. For British philosopher Thomas Hill Green, regulation (...) of alcohol sales emerged from the social ideal. Green argued that policy interventions, including restricted opening hours and locations, improved the conditions for humans to flourish. Green offers a compelling political vision but fails to account for the fact pleasure is also an inherent good. He focused excessively on our social nature, excluding our more pleasure-seeking and egoistic characteristics. In contrast, a more realistic and complete vision of human flourishing can be found in an amended version of Gerald’s Dworkin’s arguments. In conclusion, this paper argues drug policy makers should remain committed to the harm principle as applied to criminal law whereby a person should never be criminalized for self-harm. Such a limit on paternalistic interventions is deemed necessary when eudaimonia is the end of government action. In practical terms, this means that the criminalization of drug use, as opposed to drug production, is always unjust. (shrink)

According to the norm of policy equipoise, it is permissible to randomly assign participants to two or more interventions in a public policy randomized controlled trial (RCT) when there is meaningful uncertainty among the relevant expert community regarding which intervention is superior. While this norm is gaining traction in the research ethics literature, the idea of interventional superiority remains unclear. Is one intervention superior to another if it is reasonably expected to realize one outcome of interest more (...) effectively, even though there is uncertainty regarding other outcomes of interest? Or must an intervention be reasonably expected to realize all outcomes of interest more effectively? I address this question in this paper. My aim is to develop and defend an account of interventional superiority for policy RCTs that are authorized, funded, or conducted by government institutions. I defend the greatest value view, according to which one intervention is superior to another if and only if it is reasonably expected to more effectively realize a set of outcomes with greater value. (shrink)

Globally, the population is ageing, which has serious consequences for businesses. The prosperity of companies is crucially dependent on the ability to effectively manage their employees, including older workers. Best practice in age management is defined as those measures that combat age barriers and/or promote age diversity. These measures may entail specific initiatives aimed at particular dimensions of age management; they may also include more general employment or human resources policies that help to create an environment in which individual employees (...) can achieve their potential without being disadvantaged by their age. Promoting early retirement is generally not encouraged. Companies now have to encourage longer working lives. Much needs to be done to ensure that work remains a positive experience for workers throughout their career trajectories, and it does not damage their health. It has been found by studies that health is significantly related to retirement timing, influences work performance, and health-related organisational policies can positively influence employee retention. The major contemporary challenges to health at work are those associated with the way work, and work organisations are designed and managed. This is especially true for older workers. A comprehensive and effective approach towards age management can be very beneficial for them. How should companies implement age management? Some possible ways are set out in this policy brief below, which focuses on best practices in age management regarding ergonomic aspects and health interventions for older workers at an organisational level. The intention is to discuss the current situation and to illustrate some organisational techniques in selected countries. This policy brief can serve as an inspiration for, among others, companies and policymakers. Recommendations for successful practice are included. In total, this policy brief covers 8 COST member countries to give a glimpse of the current situation of best practice in age management and show how companies in various states deal with ergonomic aspects, health interventions and the ageing of their labour force. (shrink)

The increased use of human biological material for cell-based research and clinical interventions poses risks to the privacy of patients and donors, including the possibility of re-identification of individuals from anonymized cell lines and associated genetic data. These risks will increase as technologies and databases used for re-identification become affordable and more sophisticated. Policies that require ongoing linkage of cell lines to donors’ clinical information for research and regulatory purposes, and existing practices that limit research participants’ ability to control (...) what is done with their genetic data, amplify the privacy concerns. (shrink)

The judiciary is a key policy actor that is involved in deciding health rights and policy by intervening in the policy process through a variety of judicial mechanisms, yet the appropriate extent of its involvement remains contentious. Taking the competence objection seriously requires understanding it as an epistemic problem about how courts assess empirical and scientific evidence in order to competently adjudicate controversial health claims. This paper examines recent advances in social epistemology to develop insights for the (...) epistemic competence of the judiciary from a system‐oriented approach. I outline three epistemic features that set the judiciary and the judicial decision‐making process apart from other types of decision‐makers in health policy: the distribution of epistemic power, the epistemic authority of a justified believer, and the principle of disinterestedness. Finally, I relate these insights back to the judicial decision‐making process with a specific focus on recent court decisions in health rights and health policy in Chile. (shrink)

Robert H. Blank has set his sights high in Intervention in the Brain. He presents a carefully researched and readable account of the ethical and political issues that arise as a result of our increased ability to intervene on the brain; and with this, he hopes to provide a foundation for future debates about a wide variety of important issues. I applaud his project, and agree wholeheartedly that we should be thinking more carefully about the political implications of research in (...) neuroscience and neuropsychology. But I am skeptical of Blank’s approach, and believe he has bitten off more than he can effectively chew in this book.The first three chapters are designed to get non-experts up to speed on current issues .. (shrink)

BackgroundIn 2004, patient advocate groups were major players in helping pass and implement significant public policy and funding initiatives in stem cells and regenerative medicine. In the following years, advocates were also actively engaged in Washington DC, encouraging policy makers to broaden embryonic stem cell research funding, which was ultimately passed after President Barack Obama came into office. Many advocates did this because they were told stem cell research would lead to cures. After waiting more than 10 years, (...) many of these same patients are now approaching clinics around the world offering experimental stem cell-based interventions instead of waiting for scientists in the US to complete clinical trials. How did the same groups who were once the strongest supporters of stem cell research become stem cell tourists? And how can scientists, clinicians, and regulators work to bring stem cell patients back home to the US and into the clinical trial process?DiscussionIn this paper, we argue that the continued marketing and use of experimental stem cell-based interventions is problematic and unsustainable. Central problems include the lack of patient protection, US liability standards, regulation of clinical sites, and clinician licensing. These interventions have insufficient evidence of safety and efficacy; patients may be wasting money and time, and they may be forgoing other opportunities for an intervention that has not been shown to be safe and effective. Current practices do not contribute to scientific progress because the data from the procedures are unsuitable for follow-up research to measure outcomes. In addition, there is no assurance for patients that they are receiving the interventions promised or of what dosage they are receiving. Furthermore, there is inconsistent or non-existent follow-up care. Public policy should be developed to correct the current situation.ConclusionThe current landscape of stem cell tourism should prompt a re-evaluation of current approaches to study cell-based interventions with respect to the design, initiation, and conduct of US clinical trials. Stakeholders, including scientists, clinicians, regulators and patient advocates, need to work together to find a compromise to keep patients in the US and within the clinical trial process. Using HIV/AIDS and breast cancer advocate cases as examples, we identify key priorities and goals for this policy effort. (shrink)

The marketing of unproven direct-to-consumer stem cell interventions is becoming widespread in Canada. There is little evidence supporting their use and they have been associated with a range of harms. Canada has been slower to act against clinics offering these interventions than other jurisdictions, including the United States. Here, we outline the regulatory and policy tools available in Canada to address this growing problem. Health Canada’s regulations governing cell therapies are complex, but recent statements make it clear (...) that Health Canada believes it has jurisdiction over many of the currently marketed stem cell interventions. Still, further regulatory clarity is needed from Health Canada, as are increased directed enforcement efforts on interventions that fall within their scope. The Competition Bureau, via the Competition Act, prohibits advertisers from making materially false or misleading promotional representations. The Competition Bureau could collaborate with the scientific community to analyze the claims of existing clinics in Canada, and impose sanctions upon those who breach the established standard. Professional regulators, including provincial colleges of physicians and surgeons, have considerable power over what products and services their members can offer. Every college of physicians in Canada requires, via policy and codes of ethics, that doctors maintain evidence-based practices. This requirement is incompatible with offering many unproven stem cell interventions. Litigation may be another tool, including the use of fraud, misrepresentation and/or negligence claims for failing to meet the required standard of care. Finally, political pressure on federal and provincial lawmakers could encourage changes to marketing, cell therapy and professional regulations that would allow a more comprehensive response. In sum, there are many existing tools that can be used to protect the public from unproven stem cell interventions. Increased bureaucratic will and grassroots efforts are needed in order to effect a positive policy response. (shrink)

This essay examines the debate surrounding New York City’s controversial diabetes registry program. Exploring the tensions between public health officials and privacy advocates, the article explores how diabetes is imagined in the public sphere. Although rhetorics underscoring privacy may seem the more progressive discourse, I argue New York City’s Department of Health and Mental Hygiene has the more forward-looking plan, attempting to reconstitute diabetes not as a chronic condition necessitating individual management but as a disease that requires systemic intervention.

Organisations increasingly use automated decision-making systems (ADMS) to inform decisions that affect humans and their environment. While the use of ADMS can improve the accuracy and efficiency of decision-making processes, it is also coupled with ethical challenges. Unfortunately, the governance mechanisms currently used to oversee human decision-making often fail when applied to ADMS. In previous work, we proposed that ethics-based auditing (EBA)—that is, a structured process by which ADMS are assessed for consistency with relevant principles or norms—can (a) help organisations (...) verify claims about their ADMS and (b) provide decision-subjects with justifications for the outputs produced by ADMS. In this article, we outline the conditions under which EBA procedures can be feasible and effective in practice. First, we argue that EBA is best understood as a ‘soft’ yet ‘formal’ governance mechanism. This implies that the main responsibility of auditors should be to spark ethical deliberation at key intervention points throughout the software development process and ensure that there is sufficient documentation to respond to potential inquiries. Second, we frame AMDS as parts of larger sociotechnical systems to demonstrate that to be feasible and effective, EBA procedures must link to intervention points that span all levels of organisational governance and all phases of the software lifecycle. The main function of EBA should, therefore, be to inform, formalise, assess, and interlink existing governance structures. Finally, we discuss the policy implications of our findings. To support the emergence of feasible and effective EBA procedures, policymakers and regulators could provide standardised reporting formats, facilitate knowledge exchange, provide guidance on how to resolve normative tensions, and create an independent body to oversee EBA of ADMS. (shrink)

The aim of this article is to describe the consequences of state intervention at the local level after a destructive earthquake hit the south of Italy in 1980. The kind of intervention adopted, the amount of financial investment and the way in which it was distributed affected the social and economic equilibrium of the local community in terms of perceptions of trust, patronage and effects on development.

Government agencies and nonprofit organizations have increasingly turned to randomized controlled trials (RCTs) to evaluate public policy interventions. Random assignment is widely understood to be fair when there is equipoise; however, some scholars and practitioners argue that random assignment is also permissible when an intervention is reasonably expected to be superior to other trial arms. For example, some argue that random assignment to such an intervention is fair when the intervention is scarce, for it is sometimes fair to (...) use a lottery to allocate scarce goods. We investigate the permissibility of randomization in public policy RCTs when there is no equipoise, identifying two sets of conditions under which it is fair to allocate access to a superior intervention via random assignment. We also reject oft-made claims that alternative study designs, including stepped-wedge designs and uneven randomization, offer fair ways to allocate beneficial interventions. (shrink)

Governments are increasingly using randomized controlled trials (RCTs) to evaluate policy interventions. RCTs are often understood to provide the highest quality evidence regarding the causal efficacy of an intervention. While randomization plays an essential epistemic role in the context of policy RCTs however, it also plays an important distributive role. By randomly assigning participants to either the intervention or control arm of an RCT, people are subject to different policies and so, often, to different types and levels (...) of benefits. In this paper, I identify one necessary condition as well as a set of sufficient conditions for the permissible use of random assignment by government agencies. I argue first that random assignment is permissible only if it is consistent with governments’ duty to realize morally important outcomes. I argue second that random assignment is permissible in cases where investigators are in a state of genuine equipoise regarding all arms of the experiment and the policy to which people have a claim of justice. Finally, I defend a set of conditions under which random assignment is permissible in cases where one or more arms of a policy RCT are reasonably expected to be either superior or inferior to this policy. (shrink)

While nudging has garnered plenty of interdisciplinary attention, the ethics of applying it to climate policy has been little discussed. However, not all ethical considerations surrounding nudging are straightforward to apply to climate nudges. In this article, we overview the state of the debate on the ethics of nudging and highlight themes that are either specific to or particularly important for climate nudges. These include: the justification of nudges that are not self-regarding; how to account for climate change denialists; (...) transparency; knowing the right or best behaviours; justice concerns; and whether the efficacy of nudges is sufficient for nudges to be justified as a response to the climate crisis. We conclude that climate nudges raise distinct ethical questions that ought to be considered in developing climate nudges. (shrink)

Public health emergencies such as pandemics can put health systems in a position where they need to ration medical equipment and interventions because the resources available are not sufficient to meet demand. In public health management, the fair allocation of resources is a permanent and cross-sector issue since resources, and especially economic resources, are not infinite. During the COVID-19 pandemic resources need to be allocated under conditions of extreme urgency and uncertainty. One very problematic aspect has concerned intensive care (...) medicine and age discrimination has been among the most hotly discussed issues, as age has been touted as a probable criterion for selection. In this paper we analyse some documents originating from scientific societies and medical associations, mainly related to EU sphere and available in English, French, Spanish and Italian (Switzerland, Spain, Belgium, France, England and Italy), concerning the criteria for admission to the intensive care units. We highlights how, in most of these documents, it is explicitly stated that “age itself” is not a criterion for patient selection. Our conclusion is that these criteria should be defined in advance of a crisis situation and be grounded in clinical indicators. Establishing “cut-off” policies with regard to criteria such as age or chronic disability is definitely an unjustifiable form of discrimination even in the context of a public health emergency. (shrink)

In this article, I ask whether a principle analogous to the principle of clinical equipoise should govern the design and conduct of RCTs evaluating the effectiveness of policy interventions. I answer this question affirmatively, and introduce and defend the principle of policy equipoise. According to this principle, all arms of a policy RCT must be, at minimum, in a state of equipoise with the best proven policy that is also morally and practically attainable and sustainable. (...) For all arms of a policy RCT, policy experts must either reasonably disagree about whether the trial arms are more effective than this policy, or know that they are. (shrink)

abstract Apparently, there are some important tensions that must be confronted in grappling with the issue of the permissibility of humanitarian intervention. Notably, there is the tension between respecting sovereignty and responding to the plight of the needy, that is, there is tension between respecting governments’ authority and desire for non‐interference, and respecting the individuals who suffer under their leadership. I argue that these and other tensions should be resolved in favour of protecting the individuals who suffer in humanitarian crises, (...) though the way to do this defensibly requires that we put in place many safeguards against abuse. My main theoretical argument emerges from a model of global justice that I develop. I then examine recent reports on intervention and state sovereignty compiled by an inter‐national commission in order to show that consensus is building about the permissibility of military intervention to protect fundamental human rights for vulnerable populations in certain cases. Some important public policy proposals are evolving in the direction of protecting individuals over states, but there are still some important gaps that remain between what is theoretically desirable and proposals about international law. I show where some of those gaps are and how we can close them. (shrink)

Governments are increasingly making use of field experiments to evaluate policy interventions in the spheres of education, public health and welfare. However, the research ethics literature is largely focused on the clinical context, leaving investigators, institutional review boards and government agencies with few resources to draw on to address the ethical questions they face regarding such experiments. In this article, we aim to help address this problem, investigating the conditions under which informed consent is required for ethical (...) class='Hi'>policy research conducted or authorized by government. We argue that investigators need not secure participants' informed consent when conducting government policy experiments if: the government institution conducting or authorizing the experiment possesses a right to rule over the spheres of policy targeted by the research; and data collection does not involve the violation of participants' autonomy rights. (shrink)

In our experience, public health practitioners seeking to address a health problem often have just two very basic questions about the law: how can I use the law to create new interventions, or improve existing ones, to protect the public’s health; and will the law prevent me from successfully implementing certain interventions? In this way, the law is seen as either an opportunity for intervention to affect a public health problem, or an obstacle to enacting or implementing a (...) desired intervention.In addition, because some public health practitioners may not fully understand the intricacies of a given legal area, some possible obstacles to intervention may be either real or perceived. A real legal obstacle is not necessarily an insurmountable one, but it does have genuine legal force. A perceived obstacle has little, if any, true legal application to a given kind of intervention. (shrink)

Donald VanDeVeer probes the moral complexities of the question: under what conditions is it permissible to intervene invasively in the lives of competent persons--for example, by deception, force, or coercive threat--for their own good? In a work with broad significance for law, public policy, professional-client relations, and private interactions, he presents a theory of an autonomy-respecting" paternalism. Originally published in 1986. The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished (...) backlist of Princeton University Press. These editions preserve the original texts of these important books while presenting them in durable paperback and hardcover editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905. (shrink)

The intervention stairway emerges from recognising the complexity inherent in public health issues. While the original intervention ladder is a valuable tool, it risks ignoring this complexity, narrowing our focus to individual-level interventions at the expense of systemic considerations. Some have interpreted this critique as claiming the ladder entirely precludes consideration of systemic factors.1 This is not the case. Instead, the claim is that the ladder obscures these factors, making them more challenging to recognise and incorporate into policy. (...) This critique has generated several responses. Smith and Gauthier argue that the ladder will not obscure systemic considerations as it is primarily a tool for policy evaluation, not policy creation.1 Moreover, they suggest that even if used for policy creation, the ladder will likely generate systemic interventions as these are often less intrusive. By contrast, Dawson has objected to the stairways’ focus on intrusiveness, supposedly at the expense of other values, saying, ‘the only justification for a tool such as the intervention ladder is if liberty is, implausibly, given some privileged status over other values’.2 These critiques warrant careful consideration but ultimately misunderstand the purpose of both the original ladder and the proposed stairway. Neither tool is meant to privilege liberty or be used in isolation. Rather, they are tools for weighing considerations of intrusiveness and proportionality designed to be applied within …. (shrink)

Safe and healthy housing conditions are critical to improving population health, particularly for the most vulnerable – young children, senior citizens, and individuals with chronic illnesses and disabilities – who spend more time at home and are more susceptible to illness and injury. Across the country, millions of Americans are exposed to lead, radon, asbestos, volatile organic compounds, pests, mold, carbon monoxide, and tobacco smoke in the home, affecting the air they breathe and the water they drink. These household hazards (...) are also associated with a wide range of illnesses and injuries, including asthma, cancer, falls, respiratory infections, and mental health issues. Legal and policy interventions can assist communities grappling with the adverse impacts of poor housing conditions and improve the health and safety of all residents, including vulnerable populations. (shrink)

Drawing on behavioral economics, nudges (policy interventions based on choice architecture) have the capacity to strategically shape policymaking, subtly guiding individual behavior by adjusting their decision environment. Applied to enhance vaccinations, boost retirement savings, or promote healthy habits, these interventions align with consensus-defined well-being. As governments adopt nudges, scholars have explored their role in fostering virtues. This paper argues that nudges have the potential to efficiently contribute to virtuous development by instilling and sustaining habits, respecting individual choice, (...) and ensuring deliberation. It introduces the concept of virtue nudges, emphasizing the alignment of habits with virtues for targeted behavioral change and the formation of morally virtuous habits. (shrink)

It has recently been argued that successful evidence-based policy should rely on two kinds of evidence: statistical and mechanistic. The former is held to be evidence that a policy brings about the desired outcome, and the latter concerns how it does so. Although agreeing with the spirit of this proposal, we argue that the underlying conception of mechanistic evidence as evidence that is different in kind from correlational, difference-making or statistical evidence, does not correctly capture the role that (...) information about mechanisms should play in evidence-based policy. We offer an alternative account of mechanistic evidence as information concerning the causal pathway connecting the policy intervention to its outcome. Not only can this be analyzed as evidence of difference-making, it is also to be found at any level and is obtainable by a broad range of methods, both experimental and observational. Using behavioral policy as an illustration, we draw the implications of this revised understanding of mechanistic evidence for debates concerning policy extrapolation, evidence hierarchies, and evidence integration. (shrink)

This paper critically explores the ethical dimensions of Behavioral Public Policy (BPP), a domain grounded in the understanding that human rationality is bounded and that this limitation often leads to behaviors deemed irrational. By applying the behavioral lens, which posits that people operate under bounded rationality, BPP aims to craft interventions that safeguard individuals against their biases. However, this approach raises significant ethical concerns, both in the scientific underpinnings of BPP and its application through policy interventions. (...) Accordingly, this paper examines two distinct ethical dimensions of BPP, both as a scientific discipline and through its intervention methodologies. The analysis of the first dimension argues that, viewing bounded rationality as only instrumental in decision-making processes, risks oversimplifying ethical complexities. Such simplification may ignore the moral and value-based rationalities underlying decisions, potentially misattributing instances of immorality and akrasia (the failure to act according to one's judgment) to mere deficiencies in rational thinking. Secondly, the paper examines the impact of BPP on moral behavior and character development, addressing ethical concerns like the evidentiary basis of BPP research, the bounded rationality of choice architects themselves, and the morality of behavior changes induced by policy. Overall, this article provides a much-needed examination of the moral considerations associated with behavioral strategies in public policy and its epistemological foundations, contributing to a more comprehensive understanding of their ethical implications . (shrink)

Safety assessment of technologies and interventions is often underdetermined by evidence. For example, scientists have collected evidence concerning genetically modified plants for decades. This evidence was used to ground opposing safety protocols for “stacked genetically modified” plants, in which two or more genetically modified plants are combined. Evidence based policy would thus be rendered more effective by an approach that accounts for underdetermination. Douglas (2012) proposes an explanatory approach, based on the criteria of transparency, empirical competence, internal consistency (...) of explanations, and predictive potency. However, sometimes multiple explanations can satisfy these criteria. We propose an additional criterion based on converse abduction, where explanations are selected on the basis of ontological background assumptions as well as by evidence. We then apply our proposed scheme to the case of the regulation of stacked genetically modified plants. We discuss the implications and suggest follow-up work concerning the generalizability of the approach. (shrink)

Although vaccines are considered an efficient public health tool by medical experts, in different countries, people’s confidence in them has been decreasing. COVID-19 has elevated medical scientists’ and practitioners’ social reputation, and it may have reduced global vaccination hesitancy. Still, this alone will not altogether remove the existent frictions that prevent people from complying with vaccination schedules. This paper will review the common causes behind vaccination hesitancy. It will also explore different types of public policy interventions that health (...) experts in governments and institutions employ to fight vaccine hesitancy and non-compliance. The main objective of this article is to argue that, considering the nature of the issue (vaccine hesitancy and its causes), among the various possibilities, policies based on behavioral insights can provide an effective instrument to remove those frictions. Among them, special attention will be devoted to nudges which promise efficiency while avoiding some of the ethical and political costs of other interventions, thanks to their libertarian paternalistic frame. The article concludes by suggesting that public health policymakers should consider the libertarian paternalistic approach of nudges when deploying interventions that aim at changing people’s attitudes and behavior. (shrink)

There are grave issues with how the U.K. government approaches the issue of wellbeing. Specifically, policy interventions that might improve the material conditions of citizens are being down-played, and at times out-rightly dismissed. Instead, an individualist, instrumental message is being promoted, namely, that the best way to improve wellbeing is by improving individual happiness and mental health. I argue that this instrumental message – which in practice blames the victims for their lack of happiness and removes state responsibility (...) – can be made to sound feasible because of a reliance on positivist-based research, whether obtained objectively or subjectively. In this paper, I therefore detail the failings of mainstream wellbeing research and its policy conclusions, and argue that critical realism offers solutions. (shrink)

This leadoff piece examines the ethics of intervention in light of recent policy and academic debates on the subject.