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


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: