Smoking is disproportionately common among the disadvantaged, both within many countries and globally; the burden associated with smoking is, therefore, borne to a great extent by the disadvantaged. In this paper, I argue that this should be regarded as a problem of social justice. Even though smokers do, in a sense, ‘choose’ to smoke, the extent to which these choices can legitimise the resulting inequalities is limited by the unequal circumstances in which they are made. An analysis of the empirical (...) literature reveals a variety of factors—such as targeted advertising, unequal dissemination of information about the health risks of smoking and inequalities in smoking norms—that make the disadvantaged more likely to become smokers and less likely to quit successfully. The paper then considers a range of common tobacco control policies from the perspective of social justice. The social justice perspective developed here poses a challenge for policy-makers: on the one hand, social justice concerns strengthen the case for tobacco control policies because such policies disproportionately benefit the health of the disadvantaged. At the same time, however, we must be particularly sensitive to any harms associated with such policies because such burdens, too, will fall largely on the disadvantaged. (shrink)

Recent food emergencies throughout the world have raised some serious ethical and legal concerns for nations and health organizations. While the legal regulations addressing food risks and foodborne illnesses are considerably varied and variously effective, less is known about the ethical treatment of the subject. The purpose of this article is to discuss the roles, justifications, and limits of ethics of food safety as part of public health ethics and to argue for the development of this timely and emergent field (...) of ethics. The article is divided into three parts. After a short introduction on public health ethics, all levels of food safety processes are described and the role that ethics play in each of these levels is then analyzed. In the second part, different models describing the function of food law are examined. The relationship between these models and the role of ethics of food safety is assessed and discussed in the final part, leading to some relevant comments on the limits of the role and effect of ethics of food safety. (shrink)

Background: Physicians, if affected by transmissible or impairing diseases, could be hazardous for third persons. Aim: To solve the apparent chasm between patient’s and sick worker’s rights, a consensus-building process leading to hospital-wide policies is the better alternative to individual decision making. Conclusions: Policies have to balance the rights of the sick worker, the right of the other workers, patients and customers, and society’s expectations.

The major normative recommendations in the literature on food risk communication can be summarized in the form of seven practical principles for such communication: (1) Be honest and open. (2) Disclose incentives and conflicts of interest. (3) Take all available relevant knowledge into consideration. (4) When possible, quantify risks. (5) Describe and explain uncertainties. (6) Take all the public's concerns into account. (7) Take the rights of individuals and groups seriously. We show that each of these proposed principles can be (...) justified both in terms of more fundamental ethical principles and instrumentally in terms of the communicating agent's selfinterest. The mechanisms of this concordance of justifications are discussed. It is argued that the concordance is specific for areas such as food risks in which agents such as companies and public authorities are highly dependent on the public's trust and confidence. The implications of these findings both for moral philosophy and for practical food risk communication are discussed. (shrink)

Recent discourses about the legitimacy of homeopathy have focused on its scientific plausibility, mechanism of action, and evidence base. These, frequently, conclude not only that homeopathy is scientifically baseless, but that it is “unethical.” They have also diminished patients’ perspectives, values, and preferences. We contend that these critics confuse epistemic questions with questions of ethics, misconstrue the moral status of homeopaths, and have an impoverished idea of ethics—one that fails to account either for the moral worth of care and of (...) relationships or for the perspectives, values, and preferences of patients. Utilitarian critics, in particular, endeavour to present an objective evaluation—a type of moral calculus—quantifying the utilities and disutilities of homeopathy as a justification for the exclusion of homeopathy from research and health care. But these critiques are built upon a narrow formulation of evidence and care and a diminished episteme that excludes the values and preferences of researchers, homeopaths, and patients engaged in the practice of homeopathy. We suggest that homeopathy is ethical as it fulfils the needs and expectations of many patients; may be practiced safely and prudentially; values care and the virtues of the therapeutic relationship; and provides important benefits for patients. (shrink)

This thesis is an attempt to constructively interpret and critically evaluate the liberal doctrine that we may not limit a person’s liberty for her own good, and to discuss its implications and alternatives in some concrete areas of public health policy. The thesis starts theoretical and goes ever more practical. The first paper is devoted to positive interpretation of anti-paternalism with special focus on the reason component – personal good. A novel generic definition of paternalism is proposed, intended to capture, (...) in a generous fashion, the object of traditional liberal resistance to paternalism – the invocation of personal good reasons for limiting of or interfering with a person’s liberty. In the second paper, the normative aspect of this resistance is given a somewhat technical interpretation in terms of invalidation of reasons – the blocking of reasons from influencing the moral status of actions according to their strength. It is then argued that normative anti-paternalism so understood is unreasonable, on three grounds: 1) Since the doctrine only applies to sufficiently voluntary action, voluntariness determines validity of reasons, which is unwarranted and leads to wrong answers to moral questions. 2) Since voluntariness comes in degrees, a threshold must be set where personal good reasons are invalidated, leading to peculiar jumps in the justifiability of actions. 3) Anti-paternalism imposes an untenable and unhelpful distinction between the value of respecting choices that are sufficiently voluntary and choices that are not. The third paper adds to this critique the fourth argument that none of the action types typically proposed to specify the action component of paternalism is such that performing an action of that type out of benevolence is essentially morally problematic. The fourth paper ignores the critique in the second and third papers and proposes, in an anti-paternalistic spirit, a series of rules for the justification of option-restricting policies aimed at groups where some members consent to the policy and some do not. Such policies present the liberal with a dilemma where the value of not restricting people’s options without their consent conflicts with the value of allowing people to shape their lives according to their own wishes. The fifth paper applies the understanding of anti-paternalism developed in the earlier papers to product safety regulation, as an example of a public health policy area. The sixth paper explores in more detail a specific public health policy, namely that of mandatory alcohol interlocks in all cars, proposed by the former Swedish government and supported by the Swedish National Road Administration. The policy is evaluated for cost-effectiveness, for possible diffusion of individual responsibility, and for paternalistic treatment of drivers. The seventh paper argues for a liberal policy in the area of dissemination of information about uncertain threats to public health. The argument against paternalism is based on common sense consequentialist considerations, avoiding any appeal to the normative anti-paternalism rejected earlier in the thesis. (shrink)

I read with interest the article by Grill and Hansson1 on epistemic paternalism in public health. It focuses on the important issue of the patient’s right to know and receive information about uncertain threats to public health. However, health and environmental scientists, professional risk managers and the general public strongly disagree about the seriousness of many risks.2 Moreover, risk is an intricate concept to give information about.There are framing effects, ….