Archive for the ‘Public Ethics’ Category

Is Antimicrobial Resistance a Slowly Emerging Disaster?

In 2015, Disaster management, Gratuitous self-promotion, Public Ethics, Publications on July 10, 2015 at 9:39 am

The problem of antimicrobial resistance is so dire that people are predicting that the era of antibiotics may be coming to an end, ushering in a ‘post-antibiotic’ era. A comprehensive policy response is therefore urgently needed. A part of this response will require framing the problem in such a way that adequately reflects its nature as well as encompassing an approach that has the best prospect of success.

A.M. Viens and Jasper Littman have recently completed a paper – available freely as an open-access article in Public Health Ethics – which considers framing the problem of antimicrobial resistance as a slowly emerging disaster, including its potential benefits and difficulties, from a conceptual and policy perspective.

A.M. Viens is also a member of the University of Southampton’s new Network for Anti-Microbial Resistance and Infection Prevention (NAMRIP). NAMRIP aims to become the first port-of-call for UK Government for the interdisciplinary approach to research and collaboration in combating the increasing resistance that microbes display to countermeasures.

A.M. Viens

Infection Control Measures and Debts of Gratitude

In 2015, Bioethics, Public Ethics, Publications on May 26, 2015 at 9:00 am

Health care workers (HCWs) returning home from Ebola-infected regions are subject to various infection control measures (ICMs), including investigative, diagnostic, and liberty-restricting measures. Public health laws justifying the use of ICMs, such as quarantine, have been invoked in recent cases involving HCWs returning home from areas affected by Ebola. In a recent commentary in the American Journal of Bioethics, Diego Silva and A.M. Viens argue that we may owe HCWs subjected to ICMs a debt of gratitude, but it is unclear what the basis of that debt is or how that debt should be paid.

The first 50 people to click here will get free access to the commentary. After the first 50 clicks, only a summary will be made available.

HEAL teaching outside the Law School

In 2014, Public Ethics, Teaching on March 17, 2014 at 8:34 am

There’s been lots going on in HEAL over the last couple of weeks, with various research papers being presented on campus, development of a HEAL consultation response regarding organ donation after brain death, and A.M. Viens jetting off to Copenhagen where he was co-organsing a conference on Public Health Ethics. Further to all this, and of course the regular path of the academic treadmill, I recently taught at the medical school to students on the MSc in Public Health Nutrition. It’s always interesting to deliver teaching outside of the familiar disciplinary frame. For this class, I was charged with introducing ideas about public health ethics, law, and governance. This means bringing a philosophical focus that places many of the students on the course outside of their academic comfort zones.

Such a foray into ‘alien’ literatures and methods means that the teaching raises distinctive challenges both for the tutor and the students. A complexity for the students in this context comes in the open nature of many of the questions asked when bringing philosophical approaches to the curriculum. In particular, this strikingly relates to questions concerning the very meanings of public health practice, and public health ethics. For example, I got very interesting and mixed answers on whether or not I, or Penny Nestel who runs the course, can be said to work in public health.

The productivity in exploring such questions doesn’t arise in reaching the ‘right’ answer. Rather, it’s about the critical self-reflection and questioning that they trigger in the students. People who study on courses such as our MSc are motivated to work in health promotion; they are committed to what Larry Gostin characterises as an article of faith in the great importance of health. My purpose in bringing a philosophical analysis to the education is not to lessen that faith, but to invite the students to scrutinise the strength and substance of its foundations.

I find the reward of this sort of teaching really comes out in the small- and whole-group discussions. A vast range of interesting ideas and questions were raised at the recent session. I’m looking forward to starting teaching the full, ten-week course on Public Health, Law, and Ethics with A.M. Viens later this year on the MSc in public health. We’ll be able there to explore philosophy and public health in a much more sustained, and deeply engaged, way.

John Coggon

This week’s joint ICJR/HEAL event – Dr John Coggon on ‘Legal Moralism and Long-Game Healthism? – the regulation of smoking’

In 2014, Meetings, Public Ethics on March 11, 2014 at 3:10 pm

This week we have a joint ICJR/HEAL event on Wednesday 12 March 2014, from 4pm in Building 54, Room 10037 (10th Floor), with John Coggon speaking on ‘Legal Moralism and Long-Game Healthism? – the regulation of smoking’.

Abstract This paper is concerned with coercive policies and regulatory strategies that aim at a prohibitionist end whilst avoiding individual legal measures that would individually provide an outright ban on an activity. It compares jurisprudential debates regarding legal moralism, which concerns the use of law as a mechanism for enforcing moral norms, with debates in public health ethics about healthism, which refers to an ideological political agenda aimed at making people behave in ways that (apparently) promote their health. It then takes as its focus the ‘end game’ agenda in tobacco policy; a strategy designed ultimately to mean that smoking will be eradicated. Against the background of ideas designed to legitimise such health policy—such as those entailed in ‘libertarian paternalism’—the paper examines whether long-game strategies avoid or are subject to concerns that apply to immediate prohibitions. In short, it explores the question: if on principled grounds we could not ban smoking overnight, (why) is it acceptable to do so over a decades-long period?

Ethics, Politics, and Georgetown Public Health Law

In 2014, Gratuitous self-promotion, Public Ethics on February 10, 2014 at 11:42 am

Last week I was delighted to visit Georgetown University. In particular, it was a great pleasure to meet up with Larry Gostin in the O’Neill Institute for National and Global Health Law. Larry’s work has been crucial in shaping contemporary understandings of public health law and ethics; my main areas of research. It was fantastic to have the opportunity to discuss with him my own teaching and research agendas, including the work that A.M. Viens and I are up to in HEAL developing specialist teaching in Public Health, Law, and Ethics for Southampton’s new MSc in Public Health.

The primary reason for my visit was to give an invited lecture to JD and LLM students studying public health law in Georgetown Law. The lecture was entitled “Political Theory in Public Health Ethics”. In part, it involved teaching some of the fundamentals (at least as I see them!) in bringing ethical analysis to public health practice and policy. However, my main aim was to challenge the students to consider not just the nature, but also the scope, of normative claims made in the name of public health. Having examined the necessary relationships between public health and law, I invited the students to think about two distinct modes of ‘doing’ public health ethics.

In relation to the first, we studied the work of scholars who are interested in theorising: we looked at ideas concerning conceptual coherence, normative and analytical rigour, and theoretical bounds (or lack of them) to claims made in public health ethics. The lecture surveyed some of the many different ethical theories that are brought to bear on public health, and scrutinised their bases and conclusions. As regards the second, we looked at ethics in public advocacy, referring to ideas such as ‘nudge’, ‘stewardship’, and the human right to health. Here we asked not just how robust these positions are in theory, but how robust we really want or need them to be in practice.

My hope with the class was that the students would address the very basics of whatever motivates their ideas about good practice in public health law and policy; to think about what makes health promotion desirable, or even an imperative (and what brakes there ought to be on health promotion). But I also hope that it left them thinking about the potentially distinguishable roles of academic and activist, and which (neither, either, or both) they would wish to assume, and on what terms.

John Coggon

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

Criminal Law and Public Health – Working at Cross-Purposes?

In 2013, Gratuitous self-promotion, News, Public Ethics on November 18, 2013 at 8:00 am

According to recent news reports, the city of Edinburgh is getting tough on those who seek sensual pleasures outside of the confines of their own homes.  The police have asked that condoms be banned from saunas as a way of trying to prevent sexual activity on the premises, and city Councillors have been asked to stop issuing licenses for saunas and massage parlours.

Besides being a naïve and impractical way to prevent people from having sex, there has been, unsurprisingly, a strong condemnation of such a move on the grounds of its potential negative effect on public health.  The charity Scot-pep, for instance, has warned that implementing the police proposal on condoms could lead a HIV epidemic, as well as the proposal to limit establishments where sex workers can meet clients puts them at greater risk from some of the inherent hazards of plying their trade outdoors.

There has been a long history in the United Kingdom of a connection between the criminal justice system and public health.  In some cases, it has been a beneficial relationship in which everything from firearms restrictions, requirements for seat belts, motorcycle helmets and child safety seats and restrictions on intoxicating substances, provide examples where the criminal justice system has been used to mitigate or prevent behaviours that are harmful to individual and population health.  Nevertheless, not all intersections of criminal justice and public health are mutually beneficial.  What is most notable is the distinct progression that has been made from a so-called “policing model of public health”, that often focused on ideas of moral hygiene and legal moralism, which remained influential in Britain into the 19th century, towards more social models of public health that focus on health promotion, harm reduction and social justice.

The recent proposals in Edinburgh reveal a conflict that can arise when approaching a social problem through a criminal justice lens rather than one of public health.  Even with a greater focus on individual and population health that shies away from ideas of moral hygiene and legal moralism, there remain important tensions between criminal justice and public health concerns – especially in cases where it concerns sex and sexuality.  What is needed is an approach in which the criminal law – as well as other areas of law – is used as a public health tool that seeks to promote health and well-being, as opposed to being used to punish individuals’ choices we find distasteful or undesirable. 

HEAL has a strong interest in public health ethics and law.  Two of its core members (A.M. Viens and John Coggon) were editors of a volume that was published this month by Cambridge University Press entitled, Criminal Law, Philosophy and Public Health Practice.  Bringing together international experts from a variety of disciplines, including law, criminology, public health, philosophy and health policy, it explores the theoretical and practical implications of how the use of criminal law may promote or hinder public health goals.

A.M. Viens

BMA Medical Book Awards: Commendation for Coggon!

In 2013, Gratuitous self-promotion, Public Ethics, Publications on September 23, 2013 at 7:52 am

On Tuesday 17th September 2013 the BMA Medical Book Awards were hosted in the Great Hall of the BMA. John Coggon’s book ‘What makes health public?’ was highly commended in the Health and Social Care category.

Cover   What Makes Health Public? 
The book is a critical monograph on public health and philosophy. It also works as a foundational resource for people working in or studying public health ethics. It is presented in three parts: Part I examines core concepts in public health, explaining what is meant, respectively, by ‘health’, ‘public’ and ‘the public’, ‘public health’, ‘public health policy’, and ‘public health law and ethics’. Part II explains why public health law and ethics require understanding of political philosophy, and demonstrates how political theory applies to health ethics and policy. Part III offers a presentation and defence of the author’s preferred political morality, explaining how the theory is developed and its implications for evaluations of potential and existing public health policy. It demands a reconceptualisation of mainstream bioethics, and reframes ethical analysis so that it can apply to contemporary problems in health policy and practice. Its objectives are both theoretical and practical. Public health ethics is a relatively new, and rapidly growing, area of study. As a practical, policy concern, it is also receiving much greater attention than has historically been the case. The book bridges gaps between literatures from a great range of sources, and brings together a wide span of discourses from policy, public and professional ethics, practice, and different academic disciplines. Its originality and importance come in its detailed, comprehensive analysis and definition of a new field of study, and its arguments for how the study of public health ethics is best undertaken. The book’s depth, breadth, and relevance make it stand out as an original contribution that will be of enduring relevance.

“The book’s chief strength is placing public health interventions, which are often seen as un- or a-political, firmly within a normative liberal framework, thereby exposing the value-loaded claims of a discipline that often sees itself as neutral or non-normatively scientific. The book makes a significant contribution to reflection on the normative basis of public health interventions. Nobody working in this field — the ethics and politics of public health interventions — can afford not to be familiar with it. It is excellent.”

The programme and list of awards winners can be read here.


Caroline Jones (John is far too modest to write this himself!).

JME Editor’s Choice: John Coggon on Elective Ventilation

In 2013, Death and dying, Public Ethics on February 21, 2013 at 7:27 am

The latest issue of the Journal of Medical Ethics (JME) is a special issue focused on ‘Elective Ventilation’. John Coggon’s paper – which he delivered as a HEAL seminar last year – has been selected as the Editor’s Choice, hence it is open access and can be read in full here.

Abstract This paper examines questions concerning elective ventilation, contextualised within English law and policy. It presents the general debate with reference both to the Exeter Protocol on elective ventilation, and the considerable developments in legal principle since the time that that protocol was declared to be unlawful. I distinguish different aspects of what might be labelled elective ventilation policies under the following four headings: ‘basic elective ventilation’; ‘epistemically complex elective ventilation’; ‘practically complex elective ventilation’; and ‘epistemically and practically complex elective ventilation’. I give a legal analysis of each. In concluding remarks on their potential practical viability, I emphasise the importance not just of ascertaining the legal and ethical acceptability of these and other forms of elective ventilation, but also of assessing their professional and political acceptability. This importance relates both to the successful implementation of the individual practices, and to guarding against possible harmful effects in the wider efforts to increase the rates of posthumous organ donation.

Jonathan Montgomery’s paper on ‘Public Ethics’ is published

In Public Ethics on January 11, 2013 at 5:32 pm

Jonathan Montgomery’s paper on the nature of ‘ public ethics’ has now been published in the Cambridge Quarterly of Health Care Ethics. Based on a presentation at a seminar on organ donation at the University of Keele, it reflects on the processes by which the Organ Donation Taskforce reached its conclusion not to propose a ‘presumed consent’ model for organ donation. It draws on the Jonathan’s experience as a member of that Taskforce and of other bodies charged with exploring ‘public ethics’, including the working party of the Nuffield Council on Bioethics on Public Health Ethics.

Jonathan argues that ‘public’ ethics is a much more contingent process than academic work and needs to (a) take into account contemporary policy debates, (b) be expressed in terms that are sufficiently close to the prevailing professional discourse to have a reasonable hope of reception, (c) assess how positions will be represented in the media and what behavioural changes will follow in the actual political context, (d) create workable compromise formulations, from which people can reason even if they reach them by different arguments.

Critiques of ‘public ethics’ need to take these features into account. He discusses the way in which a key concept in the Nuffield Council’s Public Health: Ethical Issues report, ‘stewardship’, has been examined and criticised by academics (including fellow HEAL member John Coggon in both his seminal book What Makes Health Public? and articles in the Journal of Medical Ethics and the Northern Ireland Legal Quarterly). Jonathan contends that the approach taken in the report is both explicable and defensible when seen as an exercise in public ethics, even though it may be more difficult to defend as an academic position. Criticism needs also to be sensitive to the fact that pronouncements on ‘public ethics’ are an exercise in persuasion whose audience is not academics. This may excuse the use of familiar but imperfect paradigms for analysis and a degree of compromise between committee members. It does not justify incoherent arguments.

Jonathan goes on to argue that there are some specific issues which present a greater challenge for ‘public ethics’ than for personal academic contributions. He suggests that greater attention must be paid to the difficulties for ‘public ethics’ of dealing with public opinion and seeks to explain how the Organ Donation Taskforce took into account public views it thought were based on flawed assumptions. He examines how bodies charged with considering ‘public ethics’ should address controversies where lay and professional understandings of what counts as evidence diverge. He also considers the implications of the contingencies of the socio-political contexts for ‘public ethics’ for analysis based on comparative work (both over time and between countries). This is a commonly used approach, but fraught with difficulties.