South Africa has the highest rate of foetal alcohol syndrome (FAS) in the world. The problem of alcohol abuse in pregnancy has very deep historical roots that are intertwined with the injustices of both apartheid and pre-apartheid colonialism. Much of the research that is being done in these communities is focused on identifying the epidemiological variables associated with these patterns of alcohol abuse. The underlying reasons as to why these patterns continue seem to remain largely obscured from view. In this (...) article, I apply the theory proposed by Powers and Faden of social justice as a ‘moral foundation for public health and health policy’ to the problem of FAS in South Africa. The objective of this application is two-fold: first, to critically explore the additional insights and alternative perspectives to the problem of FAS that this approach may provide and second, to assess the utility of the theory when applied directly to a specific public health problem. I conclude by noting that although this approach could result in the kind of ‘public health scope creep’ that has been criticized by various authors, it does provide fresh insights to the problem of FAS in South Africa. (shrink)

Powers and Faden argue that social justice ‘is concerned with securing and maintaining the social conditions necessary for a sufficient level of well-being in all of its essential dimensions for everyone’ (2006: 50). Moreover, social justice is concerned with the ‘achievement of well-being, not the freedom or capability to achieve well-being’ (p. 40). Although Powers and Faden note that an agent alone cannot achieve well-being without the necessary social conditions of life (e.g. equal civil liberties and basic material resources, such (...) as food and shelter), it seems that achievement requires that an agent actually pursue the six dimensions of well-being. In this article, I question the extent to which an individual has an obligation to achieve well-being, even if he or she would choose to do otherwise. For example, can an agent choose to forgo being healthy even if all the social conditions are met in her life, thereby choosing to not achieve well-being? It remains unclear how the dimension of self-determination coheres with the remaining five dimensions of well-being and the extent of society’s obligations toward an individual’s achievement of well-being, even in those instances when society’s actions may go against an individual’s right to self-determination. (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)

Social justice has strong historical roots in public health. This does not mean that we always understand what it entails when conducting an ethical analysis of a particular public health program. This article shows that Powers and Faden’s theory of social justice can provide important insights and nuance to such an analysis. The Ontario human papilloma virus vaccination program that is underway in Canada provides an important and timely case where we can surface ethical issues pertaining to social justice that (...) may otherwise remain unarticulated in the context of this program. This analysis focuses on the normative issues raised by the prioritization of a school-based program for girls only. It also examines the relevant domains of well-being identified in Powers and Faden’s theory to see whether the program is likely to enhance the well-being of those for whom it is most important. Finally, the role of vaccines in general in promoting well-being is discussed. (shrink)

While Powers and Faden do not consider possible anti-paternalism objections to their view, there are two variants of this objection that a social justice perspective is susceptible to. It is worth exploring which responses to such objections may be less promising than others. It is argued that for most public health measures targeting the disadvantaged, theorists and practitioners taking a social justice perspective should bite the paternalist bullet. Insofar as the government has the ability to reduce mortality and morbidity within (...) the population in a way that is fair and in everyone’s interests, then the use of paternalistic means or resultant paternalistic effects should be thought to be the lesser evil. (shrink)

The goal of this article is to explore how a social justice framework can help illuminate the role that consent should play in health and science policy. In the first section, we set the stage for our inquiry with the important case of Henrietta Lacks. Without her knowledge or consent, or that of her family, Mrs. Lacks’s cells gave rise to an enormous advance in biomedical science—the first immortal human cell line, or HeLa cells.