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Posts Tagged ‘A.M. Viens’

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

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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

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