Obesity has tripled in the last 50 years, affecting more than 650 million people. Radical treatment options for obesity, which has become a global pandemic, are limited. Today, the focus of health research, including obesity, is autonomy. In our study, instead of adopting an absolute definition of autonomy, it was aimed to determine how autonomy in obesity is affected and interpreted by various factors by taking into account multiple definitions of autonomy. Responsibility for the prevention of obesity is placed either (...) on individuals or on the government due to its policies towards public health. While those who put the responsibility on individuals strengthen the stigmatizing aspect of obesity, those who hold the government responsible undermine the autonomy of individuals living with obesity. In cases where autonomy may be lost, the solution lies in providing more autonomy. (shrink)

BackgroundHealth screening is undertaken to identify individuals who are deemed at higher risk of disease for further diagnostic testing so that they may possibly benefit from interventions to modify the natural course of disease. In Singapore, screening tests are widely available in the form of a package, which bundles multiple tests in one session and commonly includes non-recommended tests. There are various ethical issues associated with such testing as they may not be clinically appropriate and can result in more harm (...) than benefit. This article describes the practice of health screening packages, identifies the ethical issues arising from such packages and discusses the implications of these ethical issues on policy and practice of screening in Singapore.MethodsA content analysis of the websites of providers offering general health screening packages to individuals was conducted. A total of 14 health screening package providers were analysed for how packages were conducted and promoted, how clinically appropriate screening tests were, and the price range and composition of screening packages. A normative ethical analysis based on the four principles approach of beneficence, non-maleficence, autonomy and justice in biomedical ethics was used.ResultsTwelve of the 14 providers included non-recommended tests such as tumour markers, treadmill stress tests and MRI scans in their general health screening packages. Package prices ranged from S$26 to S$10,561, with providers charging higher when more tests were included. Health screening packages were broadly conducted in three stages: the offer and selection of a health screening package; medical assessment and performance of screening tests; a post-screening review. While material provided by all providers was factual, there was no information on the potential risks or harms of screening.ConclusionSeveral ethical issues were identified that should be addressed with regard to health screening packages in Singapore. A key issue was the information gap between providers and patients, which may result in patients undergoing inappropriate testing that may be more harmful than beneficial. Health screening packages can stimulate unnecessary demand for healthcare and contribute to an inequitable distribution of healthcare resources. (shrink)

Most research ethics literature on vulnerability focuses on the vulnerability of individuals and populations defined by the potential vulnerability of their members. However, research involving human participants does not always take the individual as the unit of analysis: political experiments may apply an intervention to a community as a whole. This paper argues that community-level vulnerability is not reducible to the sum of the vulnerabilities of community members, and that there is thus a need to consider vulnerability at the community (...) level of analysis when analyzing the ethical implications of political field experiments. I first review ethical literature on community intervention research and the emerging scholarship on the ethics of political field experiments. I then highlight key accounts of the concept of vulnerability at an individual level. Drawing on Whitfield’s concept of “collective wrongs,” I argue that communities can be negatively affected in ways that are distinct from harms to individual community members, and that variation in susceptibility to such wrongs at the community level is largely consistent with existing conceptualizations of vulnerability. I suggest questions that researchers should consider when designing political field experiments to ensure that community-level vulnerabilities are taken into account. (shrink)

The purpose of this article is to argue for a position holding that epigenetic responsibility primarily should be a political and not an individual responsibility. Epigenetic is a rapidly growing research field studying regulations of gene expression that do not change the DNA sequence. Knowledge about these mechanisms is still uncertain in many respects, but main presumptions are that they are triggered by environmental factors and life style and, to a certain extent, heritable to subsequent generations, thereby reminding of aspects (...) of Lamarckism. Epigenetic research advances give rise to intriguing challenges for responsibility relations between the society and the individual. Responsibility is commonly understood in a backwards-looking manner, identifying causally responsible actors to blame for a bad outcome. If only a backwards-looking responsibility model is applied, epigenetics might give rise to arduous responsibility ascriptions to individuals for their health and the health of their future descendants. This would put heavy responsibility burdens on actors constrained by unequal social and economic structures. In contrast, a forward-looking responsibility notion takes account of structural conditions and pay attention to who is best placed to do something about conditions contributing to bad outcomes. A forward-looking responsibility notion would partly free disadvantaged individuals from responsibility, and identify actors with power and capacity to do something about structural factors constraining genuine choice. (shrink)

Critical literatures, and public discourses, on public health policies and practices often present fixated concerns with paternalism. In this paper, rather than focus on the question of whether and why intended instances of paternalistic policy might be justified, we look to the wider, real-world socio-political contexts against which normative evaluations of public health must take place. We explain how evaluative critiques of public health policy and practice must be sensitive to the nuance and complexity of policy contexts. This includes sensitivity (...) to the ‘imperfect’ reach and application of policy, leading to collateral effects including collateral paternalism. We argue that theoretical critiques must temper their demandingness to real-world applicability, allowing for the detail of social and policy contexts, including harm reduction: apparent knock-down objections of paternalism cannot hold if they are limited to an abstract or artificially-isolated evaluation of the reach of a public health intervention. (shrink)

Liberty-restricting measures have been implemented for centuries to limit the spread of infectious diseases. This article considers if and when it may be ethically acceptable to impose selective liberty-restricting measures in order to reduce the negative impacts of a pandemic by preventing particularly vulnerable groups of the community from contracting the disease. We argue that the commonly accepted explanation—that liberty restrictions may be justified to prevent harm to others when this is the least restrictive option—fails to adequately accommodate the complexity (...) of the issue or the difficult choices that must be made, as illustrated by the COVID-19 pandemic. We introduce a dualist consequentialist approach, weighing utility at both a population and individual level, which may provide a better framework for considering the justification for liberty restrictions. While liberty-restricting measures may be justified on the basis of significant benefits to the population and small costs for overall utility to individuals, the question of whether it is acceptable to discriminate should be considered separately. This is because the consequentialist approach does not adequately account for the value of equality. This value may be protected through the application of an additional proportionality test. An algorithm for making decisions is proposed. Ultimately whether selective liberty-restricting measures are imposed will depend on a range of factors, including how widespread infection is in the community, the level of risk and harm a society is willing to accept, and the efficacy and cost of other mitigation options. (shrink)