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Archive for January, 2014|Monthly archive page

Public Health Ethics, Policy, and the Long Game

In 2014, Public Ethics on January 21, 2014 at 10:41 am

I’m writing this post in a rather sparse corner of Düsseldorf Airport, waiting to head homewards after a very stimulating two-day workshop on public health ethics. Organised by Professor Thomas Schramme and Professor Stefan Huster, at the Centre for Interdisciplinary Research, the workshop had the theme “Individual Liberty and Problems of Justice in Public Health Ethics”. It formed part of a wider, on-going research agenda that is being pursued at ZiF.

Both A.M. Viens and I attended this workshop, which had paper presentations from me, Steve Edwards, Stephen Holland, Sridhar Venkatapuram, and Kalle Grill. Intellectually it was both invigorating and challenging, with about an hour’s in-depth discussion given to each paper. My own contribution, entitled “Public Health Ethics and some Problems of Incomplete Theorising,” was based on a project I’ve been developing for some time. Working from a very broad understanding of public health (and thus also of public health ethics, law, and regulation), I sought to explore two things.

First up, I explained some basic analytical matters that I see as necessarily entailed in public health ethics. These are all built around the (widely accepted) idea that it requires us to examine freedoms and obligations concerning social, political, and commercial institutions as well as persons and populations, so should be framed in terms of political philosophy. Given that situation, and a heavy focus that inevitably falls on concerns for liberty (is this a hangover from bioethics, a ‘liberal thing’, or something else…?), I propose that a good way to enter analysis is by starting with a situation where we (purport to) give absolute respect to autonomy; philosophical anarchism. By considering the reasons why we would want to live in a political system rather than a state of nature (assuming that we would!), we present our reasons for accepting government, assessing how and why interferences with liberty are legitimate or desirable, and what values other than liberty can form the basis of political obligation. These sorts of considerations, I argued, are fundamental to, and must come prior to, any claims about specific public health imperatives.

Second, and at greater length, I explored an issue that I related to debates on theory and application of libertarian paternalism, or ‘nudges’. I began this by noting how nudges are advocated for by parties who are themselves not committed in any sense to libertarianism. Against a background of scepticism about the trust this might allow libertarians (and others concerned with liberty) to place in champions of nudge, I went on to explore an issue that (in this context) I think has received insufficient attention: the ‘long game’ in health law and policy. Here we might consider policy agendas that can only be implemented through progressive strategies, such as we see in the ‘denormalisation’ strategies concerning smoking. The questions I presented for discussion mixed normative and methodological inquiry: in essence, I asked whether it is soundly possible in evaluating laws, regulations, and measures to abstract individual policies (say a ban on smoking within five metres of the entrance to a public building) from the wider policy agenda of which they logically form a part (eradication of smoking through incremental policy-developments). This matter raises interesting philosophical issues concerning (amongst other things) the place of temporality in political philosophy and the role of individual preference in conceptions of coercive regulation.

John Coggon

This week’s HEAL event: Malcolm Oswald on health data

In 2014, Meetings on January 6, 2014 at 8:00 am

This week’s HEAL event is with Malcolm Oswald, from the Centre for Social Ethics and Policy at the University of Manchester, speaking on ‘Drawing the line between identifiable and anonymised health data: dilemmas for a conscientious public servant’. We will be in room 2007/4 (Law, Highfield campus), from 3-5pm on Wednesday 8 January 2014. All welcome – please let Adrian (A.M.Viens@soton.ac.uk) know if you plan to join us, so we can keep an eye on numbers.

Abstract

Researchers, commissioners, pharmaceutical companies, even the Prime Minister, want to use the “big data” within heath records for public and private good. However, the law tells us to draw a line between anonymised data which can be used for “secondary purposes” like research and commissioning, and identifiable data, which should be protected.

But where should the line be drawn? The law provides relatively little guidance. The truth is that almost all useful datasets, and any datasets for “big data” processing, fall somewhere between these two extremes. But what does that mean for policy? If “anonymised data” almost inevitably carries some small risk of identifying patients, should the public be asked for consent before anonymised data are processed? If so, how is the population to be informed and asked? Should resources be spent on such a communication campaign rather than patient care? What is a conscientious public official to do?

Happy New Year from HEAL!

In 2014, Gratuitous self-promotion, News on January 3, 2014 at 8:58 am

Having had a much needed break, things are starting to kick off again at HEAL. There are plenty of plans unfolding, both in the shorter and longer term. Whilst a month’s extension on the holiday would have been welcome, there’s a lot to be pleased to come back into work for.

There are various things happening in January. We are delighted to be playing host to Malcolm Oswald on the 8th, when we’ll hear his paper “Drawing the line between identifiable and anonymised health data: dilemmas for a conscientious public servant”. As is so often the case with questions in health policy, it will put some important matters under the spotlight with little by way of promise for helpful guidance from law itself.

The following week, both John Coggon and A.M. Viens are off to Germany for a meeting at the Center for Interdisciplinary Research at Universitat Bielefeld, on “Individual Liberty and Problems of Justice in Public Health Ethics”. It will be a fantastic chance for them to showcase some research on conceptual and normative problems at the intersection of ethics, law, and politics in health policy.

At the end of the month, when semester two starts, Natasha Hammond-Browning is picking up the Health Care Law teaching (to include a cameo from Caroline Jones!). The semester two teaching will be much more issue-led, as contrasted with the more foundational work on law and ethics in semester one. Natasha’s half of the semester will focus on beginning of life matters; questions central to her research interests. Towards the end of term, John will take over and speak to issues concerning the end of life, and public and global health.

We are pleased to announce too that John is becoming the new Editor-in-Chief of Health Care Analysis in January, and that A.M. Viens has joined the editorial board. It is great that this journal, with its strong focus on philosophy and health policy, now has a firm base in HEAL.

Looking a bit further forward, we’re very excited that two of HEAL’s PhD students, Alex Chrysanthou and Emma Nottingham , were successful in 2013 in leading a bid to host the Annual Postgraduate Bioethics Conference in Southampton. The conference theme is going to be “Health Law and Bioethics at the Frontiers of Innovation.” It promises to include some excellent keynotes and top quality papers on a range of bioethical questions.

The next hidden lawmakers event, on ‘Test Case Biographies’, funded by the British Academy and The Leverhulme Trust and run by Caroline, Hazel Biggs, and Jonathan Montgomery, is on the horizon this semester, as is a meeting organised by John along with Jurgen de Wispelaere on the theme: “Towards a Republic of Health? Freedom and Solidarity in Public Health and Health Policy.” A.M. Viens is also co-organising two events in the spring. The first is a workshop on Disaster Justice, co-hosted by European Cooperation in Science and Technology (COST) and the University of Copenhagen. The second is a symposium on the Ethics of Antimicrobial Resistance, hosted by the Brocher Foundation in Geneva.

We’re also between us looking forward to hosting more visitors, making more research visits , and to participating in further public consultation responses.

There’s a lot to look forward to in 2014!