How far should we go in protecting and promoting public health? Can we force people to give up unhealthy habits and make healthier choices, or does everyone have the right to decide their own lifestyle? Should we stop treating smokers who refuse to give up smoking? Should we put a tax on fatty foods and ban vending machines in schools to address the obesity epidemic? Should parents be required to have their children vaccinated? Are some of our screening programmes unethical (...) Downs syndrome screening, for example or should we be screening people for more conditions, such as Huntington disease? Such questions are at the heart of public health ethics. Holland shows that to understand and debate these issues requires philosophy: moral philosophies, such as utilitarianism and deontology, as well as political philosophies such as liberalism and communitarianism. And philosophy informs other aspects of public health, such as epidemiology and health promotion. The aim of this book is to provide a lively, accessible and philosophically informed introduction to such issues. It is an ideal textbook for students taking courses in public health ethics. And since this book develops systematic discussions of issues in public health ethics, there is also much here to engage and challenge the more advanced reader. (shrink)

This book continues and revises the ideas of justice as fairness that John Rawls presented in _A Theory of Justice_ but changes its philosophical interpretation in a fundamental way. That previous work assumed what Rawls calls a "well-ordered society," one that is stable and relatively homogenous in its basic moral beliefs and in which there is broad agreement about what constitutes the good life. Yet in modern democratic society a plurality of incompatible and irreconcilable doctrines--religious, philosophical, and moral--coexist within the (...) framework of democratic institutions. Recognizing this as a permanent condition of democracy, Rawls asks how a stable and just society of free and equal citizens can live in concord when divided by reasonable but incompatible doctrines? This edition includes the essay "The Idea of Public Reason Revisited," which outlines Rawls ' plans to revise _Political Liberalism,_ which were cut short by his death. "An extraordinary well-reasoned commentary on _A Theory of Justice_...a decisive turn towards political philosophy." --_Times Literary Supplement_. (shrink)

In this article, we address the relevance of J.S. Mill’s political philosophy for a framework of public health ethics. In contrast to some readings of Mill, we reject the view that in the formulation of public policies liberties of all kinds enjoy an equal presumption in their favor. We argue that Mill also rejects this view and discuss the distinction that Mill makes between three kinds of liberty interests: interests that are immune from state interference; interests that enjoy a presumption (...) in favor of liberty; and interests that enjoy no such presumption. We argue that what is of focal importance for Mill in protecting liberty is captured by the essential role that the value of self-determination plays in human well-being. Finally, we make the case for the plausibility of a more complex and nuanced Millian framework for public health ethics that would modify how the balancing of some liberty and public health interests should proceed by taking the thumb off the liberty end of the scale. Mill’s arguments and the legacy of liberalism support certain forms of state interference with marketplace liberties for the sake of public health objectives without any presumption in favor of liberty. (shrink)

Responsible public policy making in a technological society must rely on complex scientific reasoning. Given that ordinary citizens cannot directly assess such reasoning, does this call the democratic legitimacy of technical public policies in question? It does not, provided citizens can make reliable second-order assessments of the consensus of trustworthy scientific experts. I develop criteria for lay assessment of scientific testimony and demonstrate, in the case of claims about anthropogenic global warming, that applying such criteria is easy for anyone of (...) ordinary education with access to the Web. However, surveys show a gap between the scientific consensus and public opinion on global warming in the U.S. I explore some causes of this gap and argue that democratic reforms of our culture of political discourse may be able to address it. (shrink)

The scientific consensus regarding anthropogenic climate change is firmly established yet climate change denialism, a species of what I call pseudoskepticism, is on the rise in industrial nations most responsible for climate change. Such denialism suggests the need for a robust ethics of inquiry and public discourse. In this paper I argue: (1) that ethical obligations of inquiry extend to every voting citizen insofar as citizens are bound together as a political body. (2) It is morally condemnable for public officials (...) to put forward assertions contrary to scientific consensus when such consensus is decisive for public policy and legislation. (3) It is imperative upon educators, journalists, politicians and all those with greater access to the public forum to condemn, factually and ethically, pseudoskeptical assertions made in the public realm without equivocation. (shrink)

The aim of this article is twofold. First is to demonstrate that most values that underpin public health policy are a source of reasonable disagreement amongst citizens to whom said policy applies....

Lockdown measures in response to the COVID-19 pandemic involve placing huge burdens on some members of society for the sake of benefiting other members of society. How should we decide when these policies are permissible? Many writers propose we should address this question using cost-benefit analysis, a broadly consequentialist approach. We argue for an alternative non-consequentialist approach, grounded in contractualist moral theorising. The first section sets up key issues in the ethics of lockdown, and sketches the apparent appeal of addressing (...) these problems in a CBA frame. The second section argues that CBA fundamentally distorts the normative landscape in two ways: first, in principle, it allows very many morally trivial preferences—say, for a coffee—might outweigh morally weighty life-and-death concerns; second, it is insensitive to the core moral distinction between victims and vectors of disease. The third section sketches our non-consequentialist alternative, grounded in Thomas Scanlon’s contractualist moral theory. On this account, the ethics of self-defence implies a strong default presumption in favour of a highly restrictive, universal lockdown policy: we then ask whether there are alternatives to such a policy which are justifiable to all affected parties, paying particular attention to the complaints of those most burdened by policy. In the fourth section, we defend our contractualist approach against the charge that it is impractical or counterintuitive, noting that actual CBAs face similar, or worse, challenges. (shrink)

We all agree that democratic decision-making requires a factual input, and most of us assume that when the pertinent facts are not in plain view they should be furnished by well-functioning scientific institutions. But how should liberal democracy respond when apparently sincere, rational and well-informed citizens object to coercive legislation because it is based on what they consider a misguided trust in certain parts of science? Cases are familiar, the most prominent concerning climate science and evolution, but one may also (...) count GMO-skepticism and vaccine-skepticism, and there are plenty of others. The paper defends what I, borrowing an expression from Badiola, call Science as Public Reason, asserting roughly that some policy-relevant factual proposition P is part of public reason if and only if there is consensus about P among scientific experts in the relevant well-functioning scientific institutions. I defend this view against the controversiality objection claiming that scientific findings cannot in this general way pass as public reason as they are sometimes controversial among reasonable citizens. My preferred line of defense is what I call Dogmatism about Science as Public Reason, which roughly amounts to insisting on Science as Public Reason on the ground that it is a philosophically well-motivated view, while conceding that it may not be acceptable to all minimally rational and well-informed individuals. (shrink)

ABSTRACT In Power Without Knowledge, Jeffrey Friedman develops a critique of social science to argue that current technocratic practices are prone to predictive failures and unintended consequences. However, he does not provide evidence that the cause he singles out—“ideational heterogeneity”—is in fact a non-negligible source of technocratic limitations, more than or alongside better-known problems such as missing data, measurement issues, interpretive difficulties, and researcher bias. Even if we grant ideational heterogeneity, Friedman’s preferred institutional solution of exitocracy does not necessarily follow. (...) His critical epistemology would also be compatible with radical forms of collective action. (shrink)

Sovereign is he who provides the exception.…The exception is more interesting than the rule. The rule proves nothing; the exception proves everything. In the exception the power of real life breaks through the crust of a mechanism that has become torpid by repetition.In spring 2020, in response to the COVID-19 crisis, world leaders imposed severe restrictions on citizens’ civil, political, and economic liberties. These restrictions went beyond less controversial and less demanding social distancing measures seen in past epidemics. Many states (...) and countries imposed universal lockdowns. Lockdowns, as we define them here, require people to stay home; in some countries and places, citizens must have ad hoc licenses to... (shrink)

ABSTRACTIn his account of public reason Rawls assumes that some facts ought to be treated as ‘fixed’, or beyond reasonable disagreement. These include, for him, facts upon which there is a scientif...

The status of scientific knowledge in political liberalism is controversial. Although Rawls argued that the noncontroversial methods and conclusions of science belong to the kind of reasons that citizens can legitimately call forth in public deliberation, critics have observed that the complexity and elaborateness of scientific arguments drive them away from the spirit of public reason, i.e., that which should reflect judgments that are the product of general beliefs and forms of reasoning found in common sense. In other words, scientific (...) claims remain as inaccessible as esoteric or religious reasons. This paper contends that this objection can be met by introducing a crucial assumption, drawn from W. V. O. Quine and the ‘naturalized epistemology’ tradition: that scientific reasoning and everyday reasoning are not two different epistemic categories but rather form a continuum. The former is just a filtered or refined version of the latter. Accordingly, evidence-based scientific reasoning is common to all citizens, regardless of their actual acceptance of specific scientific claims. Following the Quinean Assumption, political liberals may argue that, unlike religious or esoteric sources of knowledge, scientific reasoning is the expression of a cognitive operation that is fundamentally shared across comprehensive doctrines and politically reasonable individuals. (shrink)

According to John Rawls, the methods and conclusions of science—when these are non-controversial—constitute public reasons. However, several objections have been raised against this view. This paper focuses on two objections. On the one hand, the associational objection states that scientific reasons are the reasons of the scientific community, and thus paradigmatically non-public in the Rawlsian sense. On the other hand, the controversiality objection states that the non-controversiality requirement rules out their public character when scientific postulates are resisted by a significant (...) portion of the citizenry. The paper replies that both objections miss their mark. To the associational objection, it replies that the relevant test for a reason to be public is whether the reasons have been construed under the rules and constrains of a public frame of thought. Insofar as scientific methods and conclusions correspond to the principles of reasoning and rules of evidence that liberals understand as public, their associational origin is secondary. To the controversiality objection, it replies that the standard for a scientific argument to be regarded as non-controversial should refer to its degree of intra-scientific consensus, since ordinary citizens accept or reject scientific pronouncements conditioned to their particular comprehensive views. Nonetheless, a wide extra-scientific agreement on the epistemic virtues of the scientific method will be needed. The paper concludes that there is a good case to think about scientific reasons as public to the extent that scientific reasoning is a mode of inquiry that mirrors a central aspiration of Rawlsian political liberalism: having a public way of thought and an impersonal standpoint to adjudicate between competing claims. (shrink)

Two important objections have been raised against exclusivist public reason. First, it has been argued that EPR entails an unjust burden for citizens who want to appeal to non-public reasons, especially religious reasons. Second, it has been argued that EPR is based on a problematic conception of religious reasons and that it ignores the fact that religious reasons can be public as well. I defend EPR against both objections. I show that the first objection conflates two ideas of public justification (...) and that the second objection conflates two ways to understand and identify religious reasons. Ultimately, it turns out that those who defend such objections actually share the concerns that justified EPR in the first place. In other words, if we are clear about the idea of public justification and the kind of religious reasons that EPR is really about, it appears that justificatory liberals are in fact all exclusivists. (shrink)