This article is featured in a special issue dedicated to theme, "the human being in the digital era: awareness, critical thinking and political space in the age of the internet and artificial intelligence." In this article, I consider the way that social-media companies nudge us to spend more time on their platforms, and I argue that, in principle, these nudges are morally permissible: they are not manipulative and do not violate any obvious moral rules. The moral problem, I argue, is (...) not with nudging in principle but is instead with the fact that users are being nudged towards something bad for them. In practice, this often involves being nudged to spend an unhealthy amount of time using a social-media app or being nudged towards content that is bad for us, such as by promoting eating-disorder content to young girls. Since nudging is morally permissible, it is open to these companies to use the same technologies to nudge us towards the good. (shrink)

Food and beverage firms are frequently criticised for their impact on the spread of non-communicable diseases like obesity and diabetes type 2. In this article we explore under what conditions the sales and marketing of unhealthy food and beverage products is irresponsible. Starting from the notion of ordinary morality we argue that firms have a duty to respect people’s autonomy and adhere to the principle of non-maleficence in both market and non-market environments. We show how these considerations are relevant when (...) thinking about immoral behaviour in the food and beverage industry, and identify under what conditions sales and marketing of unhealthy foods and beverages to adults and children is wrong. Based on this analysis we argue that firms should take into account: whether consumers are able to identify manipulative marketing, the degree of manipulation, as well as the negative impact a product has on health. We hold that for the food industry to act responsible it should re-evaluate the marketing of unhealthy products to adults and refrain from marketing to children. We conclude this study by making several recommendations on how the food industry should interact with consumers and highlight what changes need to be made in corporate practice. (shrink)

Preventive vaccination can protect not just vaccinated individuals, but also others, which is often a central point in discussions about vaccination. To date, there has been no systematic study of self- and other-directed motives behind vaccination. This article has two major goals: first, to examine and distinguish between self- and other-directed motives behind vaccination, especially with regard to vaccinating for the sake of third parties, and second, to explore some ways in which this approach can help to clarify and guide (...) vaccination debates and policy. I propose conceiving of vaccination in terms of three basic elements: the vaccination decision-maker, the vaccine recipient and the primary beneficiary. I develop a taxonomy based on the relations between these elements to distinguish four kinds of vaccination: self-protective, paternalistic, altruistic and indirect. I finally discuss the case of human papillomavirus vaccine regulation for men and women to show how each kind of vaccination is associated with and raises specific ethical questions. (shrink)

Health-promoting nudges have been put into practice by different agents, in different contexts and with different aims. This article formulates a set of criteria that enables a thorough ethical evaluation of such nudges. As such, it bridges the gap between the abstract, theoretical debates among academics and the actual behavioral interventions being implemented in practice. The criteria are derived from arguments against nudges, which allegedly disrespect nudgees, as these would impose values on nudgees and/or violate their rationality and autonomy. Instead (...) of interpreting these objections as knock-down arguments, I take them as expressing legitimate worries that can often be addressed. I analyze six prototypical nudge cases, such as Google’s rearrangement of fridges and the use of defaults in organ donation registration. I show how the ethical criteria listed are satisfied by most—but not all—nudges in most—but not all—circumstances. (shrink)

Mill’s harm principle is commonly supposed to rest on a distinction between self-regarding conduct, which is not liable to interference, and other-regarding conduct, which is. As critics have noted, this distinction is difficult to draw. Furthermore, some of Mill’s own applications of the principle, such as his forbidding of slavery contracts, do not appear to fit with it. This article proposes that the self-regarding/other-regarding distinction is not in fact fundamental to Mill’s harm principle. The sphere of protected liberty includes not (...) only self-regarding conduct, but also actions that affect only consenting others. On the other hand, the occasional permissibility of interfering with self-regarding conduct can plausibly be explained by reference to the agent’s consent. Thus, the more important distinction appears to be that between consensual and non-consensual harm, rather than that between the self-regarding and non-self-regarding action. That is, interference can be justified in order to prevent non-consensual harms, but not to prevent consensual harms. It is argued that the harm principle, thus reformulated, both captures Mill’s intentions and is a substantively plausible position. (shrink)

With an eye on the future of global ethics, I argue that social-media technologies are not morally neutral tools but are, for all intents and purposes, a kind of agent. They nudge us to do things that are bad for us. Moreover, I argue that we have a duty to quit using social-media platforms, not just on account of possible duties to preserve our own well-being but because users are akin to test subjects on whom developers are testing new nudges, (...) and we ought to deprive them of their test subjects. (shrink)

Food-related non-communicable diseases such as obesity, type 2 diabetes and cardiovascular diseases are key threats to public health. Yet, the responsibility for food-related health harms is contested. While traditionally viewed as mainly an individual responsibility or a governmental responsibility, fingers are nowadays also pointed at the food and beverage industry, as many firms are producing and marketing unhealthy products that contribute to the rise of obesity and other food-related NCDs. Yet, does the behaviour of the industry and the impact its (...) products have on public health also give reason for moral concern? Are these firms doing anything wrong? Are there normative considerations on the basis of which it can be argued that food and beverage firms have a responsibility for public health? This thesis explores the moral grounds for firms in the food and beverage industry to address food-related public health problems, and simultaneously reflects upon what taking responsibility for these problems could entail in practice. Drawing on debates in business ethics, political philosophy, and public health ethics, it is argued that food and beverage firms have distinct responsibilities for food-related health problems, and that these responsibilities spring from considerations of _non-maleficence_, _respect for autonomy _and _justice_. The thesis makes clear how responsibility for public health can be understood as an essentially shared responsibility, and outlines what taking responsibility could entail for various firms in the food and beverage industry and makes recommendations on what kind of behaviour firms should no longer engage in. (shrink)

In this paper, I examine the question of whether there is justification for regulations that place limits on food choices. I begin by discussing Sarah Conly’s recent defense of paternalist limits on food choice. I argue that Conly’s argument is flawed because it assumes a particular conception of health that is not universally shared. I examine this conception of health in some detail, and I argue that we need to shift our focus from individual behaviors and lifestyle to the broader (...) social and environmental context. Such a shift allows us to see the ways in which industry practices are negatively impacting our well-being (a broader concept than “health”). I argue that state regulatory activity surrounding the conditions under which food is grown, processed, marketed, and sold needs to be strengthened. As a result, there are likely to be some indirect limitations on food choice. These indirect limitations are justified, but regulations in which the goal is to change individual behavior or lifestyle are not. (shrink)

Recent articles published in this journal have highlighted the shortcomings of individualistic approaches to health promotion, and the potential contributions of relational analyses of autonomy to public health ethics. I argue that the latter helps to elucidate the former, by showing that an inadequate analysis of autonomy leads to misassignment of both forward-looking and backward-looking responsibility for health outcomes. Health promotion programmes predicated on such inadequate analyses are then ineffective, because they assign responsibility to agents whose social environment inhibits their (...) ability to act on such responsibilities; inequitable, because the social barriers to autonomous agency display a socio-economic gradient; and stigmatizing, because they license blaming of individuals for their own poor health without taking into account how reasonable it is to hold these individuals responsible, given the social barriers to autonomy they face. I further sketch how incorporating a relational understanding of autonomy could help to produce health promotion programmes that do not succumb to these difficulties, while avoiding coercive paternalism, exploring potential applications in ecological approaches to health promotion. (shrink)

The spread of vaccine misinformation may contribute to vaccine refusal/hesitancy and consequent harms. Nonetheless, censorship is often rejected on the grounds of free expression. This article examines John Stuart Mill’s influential defence of free expression but finds that his arguments for freedom apply only to normal, reasonably favourable circumstances. In other cases, it may be permissible to restrict freedom, including freedom of speech. Thus, while Mill would ordinarily defend the right to express false views, such as that vaccines cause autism, (...) he might have accepted restrictions on anti-vaccine misinformation during the present pandemic. This illustrates that even the staunchest defenders of free speech can permit temporary restrictions in exceptional circumstances. (shrink)

In this article, I investigate whether states should regulate energy-drink marketing practices targeting gamers. Energy drinks are high-sugar, high-caffeine, non-alcoholic beverages that allegedly improve energy, stamina, cognitive performance, and concentration. First, I define what “gamer” means and identify the market agents that play a crucial role in the gaming community, including the energy-drink industry. In doing so, I analyze energy-drink marketing practices and explore calls for regulating them. Second, I draw parallels between regulation of energy-drink marketing and marketing of products (...) such as video games and comics with explicit violent and sexual content, tobacco, alcohol, and food high in fat, sugar, and salt. Third, I examine arguments to justify regulation of energy-drink marketing practices that target gamers. Lastly, I formulate an autonomy-based argument for regulating such marketing practices. (shrink)

One prominent line of support for nudging in screening programs is the claim that nudging can help ‘bad choosers’ — that is, it can help some patients make choices more in line with their own values and preferences. In this article, I argue that due to the presence of epistemic risk in many screening programs, the argument that nudging can help ‘bad choosers’ should be revised or rejected. Expanding on the work of Biddle, J. B. 2020. Epistemic risks in cancer (...) screening: Implications for ethics and policy. Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences 79: 101200.), I argue that epistemic risk undermines the argument that nudging can help to promote patient autonomy in the context of screening. Specifically, I argue that epistemic risk results in the inclusion of non-patient values and preferences in the screening process, which challenges the claim that nudging can help patients make choices more in line with their own values and preferences. I present four reasons to think epistemic risk undermines the argument in this way: (1) conflicting values; (2) lack of transparency; (3) limited autonomy in opting out; (4) unjustified manipulation. The presence of epistemic risk in screening programs means that nudging may not always be an effective means of promoting patient autonomy and informed consent. As such, epistemic risk poses significant challenges to at least one ethical justification of nudging in screening programs, and raises further questions about the role of nudging in promoting patient decision-making. (shrink)

Breastfeeding and human milk are the normative standards for infant feeding and nutrition. Given the documented short- and long-term medical and neurodevelopment advantages of breastfeeding, infant nutrition should be considered a public health issue and not only a lifestyle choice.In a letter sent out to 2600 hospitals across the country they [Public Citizen] demand that healthcare facilities “immediately discontinue the distribution of commercial infant formula manufacturer discharge bags,” claiming it undermines women’s success at breastfeeding. What they failed to explain is (...) why a woman’s decision regarding her own tits is anyone’s fucking business but her own.Clearly, policies to promote breast-feeding.. (shrink)

As the assumptions of perpetual economic and population growth no longer stand, the welfare systems built on such promises are in peril. Policymakers must reallocate the responsibility for providing care between generations. Democratic theories can help establish procedures for finding solutions, particularly in ageing democratic countries. By analysing existing representative and deliberative democratic theories, this paper explores how the interests of future generations could be included in such procedures. A hypothetical social health insurance scheme with the pay-as-you-go financial arrangement is (...) selected as an illustrative case. This paper argues that due to the intrinsic bias towards the current generation, both representative and deliberative democratic health policymaking are limited in making decisions that account for future generations. Instead, their interests could be at best represented by benevolent representatives. (shrink)

The curious philosopher often answers questions by raising further, more fundamental questions. How can this be fruitful and practical in the context of Wageningen University? Philosophy offers critical reflection on conceptual and normative assumptions in science and society, and that is necessary for responsible practices. I illustrate this by analyzing the concept of quality of life – a key value in the mission of our university – and by questioning current debates about responsibility for health.

The title of the article in the initial online publication was mixed up with copy editing information. The original article has been corrected.

Governments and policy-makers have of late displayed renewed attention to behavioural research in an attempt to achieve a range of policy goals, including health promotion. In particular, approaches which could be labelled as ‘nudges’ have gained traction with policy-makers. A range of objections to nudging have been raised in the literature. These include claims that nudges undermine autonomy and liberty, may lead to a decrease in responsibility in decision-making, lack transparency, involve deception, and involve manipulation, potentially occasioning coercion. In this (...) article I focus on claims of coercion, examining nudges within two of the main approaches to coercion—the pressure approach and the more recent enforcement approach. I argue that coercion entails an element of control over the behaviour of agents which is not plausibly displayed by the kinds of serious examples of nudges posited in the literature. (shrink)

Sarah Conly defends paternalistic public health policies, such as New York City’s soft drink ban, on the grounds that they promote values that people accept but have difficulty realizing, owing to their cognitive biases. In this commentary, I criticize Conly’s defense of the soft drink ban and offer my own view of the justification for paternalistic food and beverage policies. I propose that paternalistic government restrictions on food and beverage choices should address a significant health problem pertaining to a specific (...) type or class of food or beverage. There should also be substantial evidence that the restrictions are likely to be effective at dealing with the problem and that alternative ways of dealing with it, which do not involve coercion, are likely to be ineffective. (shrink)

This article analyses the paternalistic justification of the world’s first mandatory tobacco plain packaging policy, which came into force in Australia in 2012. The policy is setting international precedence, with a range of developed and developing countries planning and implementing similar policies. Understanding the paternalistic dimension of the policy is therefore of imminent international importance. The policy meets important ethical benchmarks such as respect for citizens’ self-interests and protection of others against harm. However, plain packaging faces a number of ethical (...) challenges: the policy is a controversial type of paternalism; it runs partially against the harm principle; and it fails to meet key operational criteria. (shrink)