Erik Malmqvist, Davide Fumagalli, Christian Munthe, D G Joakim Larsson
Human consumption of pharmaceuticals often leads to environmental release of residues via urine and faeces, creating environmental and public health risks. Policy responses must consider the normative question how responsibilities for managing such risks, and costs and burdens associated with that management, should be distributed between actors. Recently, the Polluter Pays Principle (PPP) has been advanced as rationale for such distribution. While recognizing some advantages of PPP, we highlight important ethical and practical limitations with applying it in this context: PPP gives ambiguous and arbitrary guidance due to difficulties in identifying the salient polluter. Moreover, when PPP does identify responsible actors, these may be unable to avoid or mitigate their contribution to the pollution, only able to avoid/mitigate it at excessive cost to themselves or others, or excusably ignorant of contributing. These limitations motivate a hybrid framework where PPP, which emphasizes holding those causing large-scale problems accountable, is balanced by the Ability to Pay Principle (APP), which emphasizes efficiently managing such problems. In this framework, improving wastewater treatment and distributing associated financial costs across water consumers or taxpayers stand out as promising responses to pharmaceutical pollution from human use. However, sound policy depends on empirical considerations requiring further study.
{"title":"Pharmaceutical Pollution from Human Use and the Polluter Pays Principle.","authors":"Erik Malmqvist, Davide Fumagalli, Christian Munthe, D G Joakim Larsson","doi":"10.1093/phe/phad012","DOIUrl":"https://doi.org/10.1093/phe/phad012","url":null,"abstract":"<p><p>Human consumption of pharmaceuticals often leads to environmental release of residues via urine and faeces, creating environmental and public health risks. Policy responses must consider the normative question how responsibilities for managing such risks, and costs and burdens associated with that management, should be distributed between actors. Recently, the Polluter Pays Principle (PPP) has been advanced as rationale for such distribution. While recognizing some advantages of PPP, we highlight important ethical and practical limitations with applying it in this context: PPP gives ambiguous and arbitrary guidance due to difficulties in identifying the salient polluter. Moreover, when PPP does identify responsible actors, these may be unable to avoid or mitigate their contribution to the pollution, only able to avoid/mitigate it at excessive cost to themselves or others, or excusably ignorant of contributing. These limitations motivate a hybrid framework where PPP, which emphasizes holding those causing large-scale problems accountable, is balanced by the Ability to Pay Principle (APP), which emphasizes efficiently managing such problems. In this framework, improving wastewater treatment and distributing associated financial costs across water consumers or taxpayers stand out as promising responses to pharmaceutical pollution from human use. However, sound policy depends on empirical considerations requiring further study.</p>","PeriodicalId":49136,"journal":{"name":"Public Health Ethics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10401492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10007385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Reinvigorating Public Health Ethics: Values, Topics and Theory","authors":"A. Dawson, L. Reid","doi":"10.1093/phe/phad018","DOIUrl":"https://doi.org/10.1093/phe/phad018","url":null,"abstract":"","PeriodicalId":49136,"journal":{"name":"Public Health Ethics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48217796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
[This corrects the article DOI: 10.1093/phe/phac030.].
[更正文章DOI: 10.1093/phe/phac030.]。
{"title":"Correction: Inequalities in the Challenges Affecting Children and their Families during COVID-19 with School Closures and Reopenings: A Qualitative Study.","authors":"","doi":"10.1093/phe/phad010","DOIUrl":"https://doi.org/10.1093/phe/phad010","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1093/phe/phac030.].</p>","PeriodicalId":49136,"journal":{"name":"Public Health Ethics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2c/63/phad010.PMC10401493.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10319335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-04eCollection Date: 2023-07-01DOI: 10.1093/phe/phad005
Jessica Nihlén Fahlquist
The COVID-19 pandemic during 2020-2022 raised ethical questions concerning the balance between individual autonomy and the protection of the population, vulnerable individuals and the healthcare system. Pediatric COVID-19 vaccination differs from, for example, measles vaccination in that children were not as severely affected. The main question concerning pediatric vaccination has been whether the autonomy of parents outweighs the protection of the population. When children are seen as mature enough to be granted autonomy, questions arise about whether they have the right to decline vaccination and who should make the decision when parents disagree with each other and/or the child. In this paper, I argue that children should be encouraged to not only take responsibility for themselves, but for others. The discussion of pediatric vaccination in cases where this kind of risk-benefit ratio exists extends beyond the 2020-2022 pandemic. The pandemic entailed a question that is crucial for the future of public health as a global problem, that is, to what extent children should be seen as responsible decision-makers who are capable of contributing to its management and potential solution. I conclude that society should encourage children to cultivate such responsibility, conceived as a virtue, in the context of public health.
{"title":"Taking Risks to Protect Others-Pediatric Vaccination and Moral Responsibility.","authors":"Jessica Nihlén Fahlquist","doi":"10.1093/phe/phad005","DOIUrl":"10.1093/phe/phad005","url":null,"abstract":"<p><p>The COVID-19 pandemic during 2020-2022 raised ethical questions concerning the balance between individual autonomy and the protection of the population, vulnerable individuals and the healthcare system. Pediatric COVID-19 vaccination differs from, for example, measles vaccination in that children were not as severely affected. The main question concerning pediatric vaccination has been whether the autonomy of parents outweighs the protection of the population. When children are seen as mature enough to be granted autonomy, questions arise about whether they have the right to decline vaccination and who should make the decision when parents disagree with each other and/or the child. In this paper, I argue that children should be encouraged to not only take responsibility for themselves, but for others. The discussion of pediatric vaccination in cases where this kind of risk-benefit ratio exists extends beyond the 2020-2022 pandemic. The pandemic entailed a question that is crucial for the future of public health as a global problem, that is, to what extent children should be seen as responsible decision-makers who are capable of contributing to its management and potential solution. I conclude that society should encourage children to cultivate such responsibility, conceived as a virtue, in the context of public health.</p>","PeriodicalId":49136,"journal":{"name":"Public Health Ethics","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10401494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10007384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
After the discovery of the origins of the new coronavirus disease 2019 (COVID-19) to be possibly wet markets in Wuhan, China, the normative questions of what ought to be the ethical relations between human beings and non-human animals have started to attract renewed interest among environmentalists. Although these are not new questions in environmental philosophy, the impact of COVID-19 across the world is challenging human beings to seriously reconsider some of these often-neglected questions. In this article, I examine COVID-19 as essentially an environmental ethical challenge. Specifically, I consider the extent to which the relationships between human and non-human animals can effectively impact the health and lives of humanity and the environment at large. I then provide some alternative ways by which human beings ought to re-think their relationships with non-human animals to avoid future catastrophes like COVID-19. I argue that the African view of animal ethics could at least provide a valuable lens through which to view correct relations between human beings and non-human animals. Ultimately, I set forth and defend an African environmental ethic for the right relations between human beings and animals and to show how such an ethic better places humanity in confronting future zoonoses.
{"title":"Approaching COVID-19 as an Environmental Ethical Problem: A Perspective from African Relational Animal Ethics","authors":"Munamato Chemhuru","doi":"10.1093/phe/phad007","DOIUrl":"https://doi.org/10.1093/phe/phad007","url":null,"abstract":"\u0000 After the discovery of the origins of the new coronavirus disease 2019 (COVID-19) to be possibly wet markets in Wuhan, China, the normative questions of what ought to be the ethical relations between human beings and non-human animals have started to attract renewed interest among environmentalists. Although these are not new questions in environmental philosophy, the impact of COVID-19 across the world is challenging human beings to seriously reconsider some of these often-neglected questions. In this article, I examine COVID-19 as essentially an environmental ethical challenge. Specifically, I consider the extent to which the relationships between human and non-human animals can effectively impact the health and lives of humanity and the environment at large. I then provide some alternative ways by which human beings ought to re-think their relationships with non-human animals to avoid future catastrophes like COVID-19. I argue that the African view of animal ethics could at least provide a valuable lens through which to view correct relations between human beings and non-human animals. Ultimately, I set forth and defend an African environmental ethic for the right relations between human beings and animals and to show how such an ethic better places humanity in confronting future zoonoses.","PeriodicalId":49136,"journal":{"name":"Public Health Ethics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43606866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Climate change continues to have profound impacts on people’s health, lives and life prospects. For the most part, people who are at highest risk from the impacts of climate change have contributed very little to the problem. This is the crux of the injustice. After I discuss the risks and contributions associated with the injustice of climate change, I turn to the issue of responsiveness: of why and how people should respond to this injustice. I avoid discussions of legal liability and focus more attention on the need to take political action to change social structures and habits. However, I realize how political engagement can prove to be ineffective, burdensome and dangerous. So in the last section, I say more about the reasons and changes that limit the effectiveness of political engagement. I suggest how we might change both the perception and practice of politics. At the end, I note two issues that I have not addressed in this limited article.
{"title":"Responding to the Injustice of Climate Change","authors":"J. Dwyer","doi":"10.1093/phe/phad008","DOIUrl":"https://doi.org/10.1093/phe/phad008","url":null,"abstract":"\u0000 Climate change continues to have profound impacts on people’s health, lives and life prospects. For the most part, people who are at highest risk from the impacts of climate change have contributed very little to the problem. This is the crux of the injustice. After I discuss the risks and contributions associated with the injustice of climate change, I turn to the issue of responsiveness: of why and how people should respond to this injustice. I avoid discussions of legal liability and focus more attention on the need to take political action to change social structures and habits. However, I realize how political engagement can prove to be ineffective, burdensome and dangerous. So in the last section, I say more about the reasons and changes that limit the effectiveness of political engagement. I suggest how we might change both the perception and practice of politics. At the end, I note two issues that I have not addressed in this limited article.","PeriodicalId":49136,"journal":{"name":"Public Health Ethics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46668581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Through users’ cross-system comparative experience engaging with the health systems in Taiwan and other countries, this article probes into their understandings and value judgments and specifically their reasonings for the ‘solidarity with whom?’ question in the health sector solidarity. With the cross-system comparison approach, the study adopted semi-structured interviews with 30 Taiwanese participants who have studied, lived or worked abroad and engaged with the health system in Canada, the USA or the UK. This approach offers the opportunity for one to evaluate the health system in the home country from a relative viewpoint from the host country. The participants suggested that the boundary of Taiwan’s National Health Insurance (NHI) should be as inclusive as possible, covering all legal residents in Taiwan regardless of their status, and that the citizens should share more financial responsibility. The ethical reasons for supporting the NHI include recognizing health sector solidarity among people, considering the coverage as a protection of the human right to health, humanitarian reasons and self-interest. Three archetypes of users emerged from the synthesis: Universalists, Rationalists and Republicans. The cross-system comparative experience makes the participants have more supportive attitudes toward the ideals of health sector solidarity.
{"title":"Universalists, Republicans and Rationalists: Exploring Health Sector Solidarity and Its Boundary through the Comparative Experience of Overseas Taiwanese","authors":"","doi":"10.1093/phe/phad006","DOIUrl":"https://doi.org/10.1093/phe/phad006","url":null,"abstract":"\u0000 Through users’ cross-system comparative experience engaging with the health systems in Taiwan and other countries, this article probes into their understandings and value judgments and specifically their reasonings for the ‘solidarity with whom?’ question in the health sector solidarity. With the cross-system comparison approach, the study adopted semi-structured interviews with 30 Taiwanese participants who have studied, lived or worked abroad and engaged with the health system in Canada, the USA or the UK. This approach offers the opportunity for one to evaluate the health system in the home country from a relative viewpoint from the host country. The participants suggested that the boundary of Taiwan’s National Health Insurance (NHI) should be as inclusive as possible, covering all legal residents in Taiwan regardless of their status, and that the citizens should share more financial responsibility. The ethical reasons for supporting the NHI include recognizing health sector solidarity among people, considering the coverage as a protection of the human right to health, humanitarian reasons and self-interest. Three archetypes of users emerged from the synthesis: Universalists, Rationalists and Republicans. The cross-system comparative experience makes the participants have more supportive attitudes toward the ideals of health sector solidarity.","PeriodicalId":49136,"journal":{"name":"Public Health Ethics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45652287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Despite extensive stigma mitigation efforts, infectious disease stigma remains common. So far, little attention has been paid to the moral psychology of stigmatizing practices (i.e. beliefs, attitudes, actions) rather than the experience of being stigmatized. Addressing the moral psychology behind stigmatizing practices seems necessary to explain the persistence of infectious disease stigma and to develop effective mitigation strategies. Our article proposes building on Jonathan Haidt's moral foundations theory, which states that moral judgements follow from intuitions rather than conscious reasoning. Conceptual analysis was conducted to show how Haidt's five moral foundations can be connected to (i) moral judgements about stigmatizing practices and (ii) stigmatizing practices themselves. We found that care/harm, fairness/cheating, loyalty/betrayal and sanctity/degradation intuitions can inform moral judgements about stigmatizing practices. Loyalty/betrayal and sanctity/degradation intuitions can sometimes also feed stigmatizing practices. Authority/subversion intuitions can inform moral judgements and stigmatizing practices towards people who disrespect authoritative rules meant to protect public health. Moral dumbfounding and posthoc reasoning might explain the persistence of stigmatizing practices. In conclusion, this study demonstrates the relevance of Haidt's approach to infectious disease stigma research and mitigation strategies. We hope that this study motivates researchers to further test and assess this approach.
{"title":"Moral Intuitions <i>About</i> Stigmatizing Practices and <i>Feeding</i> Stigmatizing Practices: How Haidt's Moral Foundations Theory Relates to Infectious Disease Stigma.","authors":"C Damsté, K Kramer","doi":"10.1093/phe/phad002","DOIUrl":"https://doi.org/10.1093/phe/phad002","url":null,"abstract":"<p><p>Despite extensive stigma mitigation efforts, infectious disease stigma remains common. So far, little attention has been paid to the moral psychology of stigmatizing practices (i.e. beliefs, attitudes, actions) rather than the experience of <i>being</i> stigmatized. Addressing the moral psychology behind stigmatizing practices seems necessary to explain the persistence of infectious disease stigma and to develop effective mitigation strategies. Our article proposes building on Jonathan Haidt's moral foundations theory, which states that moral judgements follow from intuitions rather than conscious reasoning. Conceptual analysis was conducted to show how Haidt's five moral foundations can be connected to (i) moral judgements about stigmatizing practices and (ii) stigmatizing practices themselves. We found that care/harm, fairness/cheating, loyalty/betrayal and sanctity/degradation intuitions can inform moral judgements about stigmatizing practices. Loyalty/betrayal and sanctity/degradation intuitions can sometimes also feed stigmatizing practices. Authority/subversion intuitions can inform moral judgements and stigmatizing practices towards people who disrespect authoritative rules meant to protect public health. Moral dumbfounding and posthoc reasoning might explain the persistence of stigmatizing practices. In conclusion, this study demonstrates the relevance of Haidt's approach to infectious disease stigma research and mitigation strategies. We hope that this study motivates researchers to further test and assess this approach.</p>","PeriodicalId":49136,"journal":{"name":"Public Health Ethics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10161519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9430151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This paper discusses the ethics of public health communication. We argue that a number of commonplace tools of public health communication risk qualifying as non-honest and question whether or not using such tools is ethically justified. First, we introduce the concept of honesty and suggest some reasons for thinking it is morally desirable. We then describe a number of common ways in which public health communication presents information about health-promoting interventions. These include the omission of information about the magnitude of benefits people can expect from health-promoting interventions, and failure to report uncertainty associated with the outcomes of interventions. Next we outline some forms of behaviour which are generally recognised by philosophers as being non-honest, including deception, manipulation, and so on. Finally, we suggest that many of the public health communicative practices identified earlier share features with the non-honest behaviours described and suggest this warrants reflection upon whether such non-honesty is justified by the goals of public health communication.
{"title":"A Taxonomy of Non-honesty in Public Health Communication.","authors":"Rebecca C H Brown, Mícheál de Barra","doi":"10.1093/phe/phad003","DOIUrl":"https://doi.org/10.1093/phe/phad003","url":null,"abstract":"<p><p>This paper discusses the ethics of public health communication. We argue that a number of commonplace tools of public health communication risk qualifying as non-honest and question whether or not using such tools is ethically justified. First, we introduce the concept of honesty and suggest some reasons for thinking it is morally desirable. We then describe a number of common ways in which public health communication presents information about health-promoting interventions. These include the omission of information about the magnitude of benefits people can expect from health-promoting interventions, and failure to report uncertainty associated with the outcomes of interventions. Next we outline some forms of behaviour which are generally recognised by philosophers as being non-honest, including deception, manipulation, and so on. Finally, we suggest that many of the public health communicative practices identified earlier share features with the non-honest behaviours described and suggest this warrants reflection upon whether such non-honesty is justified by the goals of public health communication.</p>","PeriodicalId":49136,"journal":{"name":"Public Health Ethics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10161520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9430158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
[This corrects the article DOI: 10.1093/phe/phad002.].
[更正文章DOI: 10.1093/phe/phad002.]。
{"title":"Correction to: Moral Intuitions <i>About</i> Stigmatizing Practices and <i>Feeding</i> Stigmatizing Practices: How Haidt's Moral Foundations Theory Relates to Infectious Disease Stigma.","authors":"","doi":"10.1093/phe/phad009","DOIUrl":"https://doi.org/10.1093/phe/phad009","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1093/phe/phad002.].</p>","PeriodicalId":49136,"journal":{"name":"Public Health Ethics","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10161515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9784681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}