Justification for coercion in a public health crisis: not just a matter of individual harm.

IF 1.6 Q2 ETHICS Monash Bioethics Review Pub Date : 2024-05-18 DOI:10.1007/s40592-024-00196-0
Lucie White
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Abstract

The COVID pandemic was an exceptional public health situation - which brought with it unprecedented restrictions across the global populace. But what was it about this pandemic which caused us to implement such drastic restrictions on liberty? Much of the ethical debate on restrictive measures such as lockdowns and vaccine requirements focused on the potential harm that individuals cause to other individuals by the risk of infection. I will suggest that this may come from a reliance on J.S. Mill's harm principle as providing the ultimate justification for coercion - i.e., the well-accepted principle that state coercion is justified in order to prevent the imposition of unacceptable risk of harm to others. Though there have been attempts, in the wider public health ethics literature, to use the harm principle as a basis for restricting contribution to collective harms, I will suggest that these attempts cannot rely on the harm principle alone. I will then turn to the ways in which an individual-based line of reasoning does not capture a distinctive sort of harm posed by the COVID pandemic (and others like it): the potential failure of healthcare systems. I will draw out three ways in which a focus on the harm that an individual poses to another individual fails to capture the full scope of harm wrought by the collapse of healthcare systems. First, it can't adequately capture the cumulative and "looping effects" of the harm caused by strained healthcare systems. Second, it fails to capture the widespread ripple effects the failure of a central societal institution can have on other institutions. And third, the failure of a healthcare system can impose "psychic costs", affecting the moral character of all members of society, reducing trust in institutions, and potentially posing an existential threat to the fabric of society. Finally, I will sketch some implications of the recognition of this distinctive sort of harm for the justification of coercive public health measures.

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公共卫生危机中的胁迫理由:不仅仅是个人伤害问题。
COVID 大流行是一次特殊的公共卫生事件--它给全球民众带来了前所未有的限制。但究竟是什么原因导致我们对自由实施如此严厉的限制?关于封锁和疫苗要求等限制性措施的伦理辩论大多集中在个人因感染风险而对他人造成的潜在伤害上。我认为,这可能是由于人们依赖 J.S. 密尔的伤害原则,将其作为强制的最终理由--即国家强制是为了防止对他人造成不可接受的伤害风险,这一原则已被广泛接受。尽管在更广泛的公共卫生伦理学文献中,有人试图将伤害原则作为限制集体伤害的基础,但我将指出,这些尝试不能仅仅依赖于伤害原则。然后,我将论述基于个体的推理如何无法捕捉到 COVID 大流行(以及其他类似流行)所造成的一种独特伤害:医疗保健系统的潜在失灵。我将从三个方面来说明,关注个体对他人造成的伤害并不能全面反映医疗系统崩溃所造成的伤害。首先,它无法充分捕捉到医疗系统紧张所造成的伤害的累积效应和 "循环效应"。其次,它未能反映出一个核心社会机构的失败可能对其他机构产生的广泛连锁反应。第三,医疗系统的失灵会造成 "心理成本",影响社会所有成员的道德品质,降低对机构的信任,并可能对社会结构的存在构成威胁。最后,我将简要说明认识到这种独特的伤害对强制性公共卫生措施的合理性的一些影响。
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来源期刊
CiteScore
2.70
自引率
6.20%
发文量
16
期刊介绍: Monash Bioethics Review provides comprehensive coverage of traditional topics and emerging issues in bioethics. The Journal is especially concerned with empirically-informed philosophical bioethical analysis with policy relevance. Monash Bioethics Review also regularly publishes empirical studies providing explicit ethical analysis and/or with significant ethical or policy implications. Produced by the Monash University Centre for Human Bioethics since 1981 (originally as Bioethics News), Monash Bioethics Review is the oldest peer reviewed bioethics journal based in Australia–and one of the oldest bioethics journals in the world. An international forum for empirically-informed philosophical bioethical analysis with policy relevance. Includes empirical studies providing explicit ethical analysis and/or with significant ethical or policy implications. One of the oldest bioethics journals, produced by a world-leading bioethics centre. Publishes papers up to 13,000 words in length. Unique New Feature: All Articles Open for Commentary
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