Health Agency and Perfectionism:The Case of Perinatal Health Inequalities

Poor pregnancy outcomes and inequalities in these outcomes remain a major challenge, even in prosperous societies that have high-quality health care and public health policy in place. In this article, we propose that justice demands the improvement of what we call the ‘health agency’ of parents-to-be as part of a response to these poor outcomes. We take health agency to have three aspects: (i) the capacity to form health-goals one has reason to value, (ii) the control one perceives to have over achieving those health-goals and (iii) the freedom(s) one has to achieve those health-goals. We will moreover argue that this demand of justice can be best based on a perfectionist rather than neutralist method of justification. Subsequently, we will argue that perfectionist policy may be paternalistic but not wrongfully paternalistic. This leads us to conclude that perfectionism should be adopted to inform and justify public health policy that is aimed at improving health agency in general and counteracting poor pregnancy outcomes and inequalities in perinatal health outcomes in particular

Before you were born: a moral exploration of parental and societal responsibilities for the health of children-to-be

The aims of this dissertation are: · To identify and describe the views of parents and caregivers on the responsibilities for the health of children-to-be in general and the responsibility to prepare for pregnancy in particular. · To provide an ethical analysis of the justifiability of unreflective behavioral interventions (nudges) aimed at benefiting the health of children-to-be. · To provide an ethical analysis of the justifiability of the use of force in pregnancy related care by considering the case of the justifiability of forced cesareans. · To identify and present the demands of justice pertaining to the improvement and securing of the health of children-to-be

Incentives for smoking cessation during pregnancy:an ethical framework

INTRODUCTION: Smoking during pregnancy increases the risk of morbidity and mortality of the mother and child. The inability of the unborn child to protect itself, raises the social and academic responsibility to protect the child from the harmful effects of smoking. Interventions including rewards ('incentives') for lifestyle changes are an upcoming trend and can encourage women to quit smoking. However, these incentives can, as we will argue, also have negative consequences, for example the restriction of personal autonomy and encouragement of smoking to become eligible for participation. To prevent these negative consequences, we developed an ethical framework that enables to assess and address unwanted consequences of incentive-based interventions whereby moral permissibility can be evaluated. METHODS: The possible adverse consequences of incentives were identified through an extensive literature search. Subsequently, we developed ethical criteria to identify these consequences based on the biomedical ethical principles of Beauchamp and Childress. RESULTS: Our framework consists of twelve criteria. These criteria concern (i) effectiveness, (ii) support of a healthy lifestyle, (iii) motivational for the target population, (iv) stimulating unhealthy behaviour, (v) negative attitudes, (vi) personal autonomy, (vii) intrinsic motivation, (viii) privacy, (ix) fairness, (x) allocation of incentives, (xi) cost-effectiveness, and (xii) health inequity. Based on these criteria, the moral permissibility of potential interventions can be evaluated. CONCLUSION: Incentives for smoking cessation are a response to the responsibility to protect the unborn child. But these interventions might have possible adverse effects. This ethical framework aims to identify and address ethical pitfalls in order to avoid these adverse effects