Global health inequalities and inequities

Inequalities of one kind or another are a ubiquitous feature of human life. The more aspects of human experience researchers measure, and the greater the accuracy with which they measure them, the more inequalities they uncover. Some inequalities are generally thought to matter more than others: movements are formed to fight for greater income equality and equal rights to democratic participation, but not for an equal distribution of television sets. Inequalities in health are often thought to be particularly difficult to justify. This article examines which health inequalities on a global scale are unjust, and considers who should have the duties to rectify these injustices

The right to public health

Much work in public health ethics is shaped by an ‘autonomy first’ view, which takes it to be axiomatic that it is difficult to justify state interference in the lives of competent adults unless the behaviours interfered with are compromised in terms of their autonomy, or would wrongfully infringe on the autonomy of others. However, such an approach is difficult to square with much of traditional public heath practice. Recent years have seen running battles between those who assume that an ‘autonomy first’ approach is basically sound (and so much the worse for public health practice) and those who assume that public health practice is basically sound (and so much the worse for the ‘autonomy first’ approach). This paper aims to reconcile in a normatively satisfying way what is best about the ‘autonomy first’ with what is best about a standard public health approach. It develops a positive case for state action to promote health as a duty that is owed to each individual. According to this view, the state violates individuals’ rights if it fails to take cost-effective and proportionate measures to remove health threats from the environment. It is thus a mistake to approach public health in the way that ‘autonomy first’ accounts do, as primarily a matter of individual entitlements versus the common good. Too little state intervention in the cause of improving population health can violate individuals’ rights, just as too much can

Morality, Dignity and Pragmatism: an Essay on the Future of Morality

This thesis is an examination and reconstruction of morality. It divides into three parts. Part one argues that morality is best considered as the tradition of ethical thinking that begins with the Stoics, develops in Christian thought and reaches its apotheosis in Kant. This tradition structures ethical thinking around three basic concepts: cosmopolitanism, or universal applicability to human beings as such, the dignity of human beings and reciprocity. It is this tradition of morality that Nietzsche sets out to destroy. Part one criticises pre-Nietzschean theories of morality, such as Kant’s, that take universal and exceptionless rules to form the core of morality. It critiques both the possibility of putting forward an adequate set of such rules and the proposed relationship between morality and human life that is implicit in these theories. Part two begins with Nietzsche’s challenge: that morality is a system of values rooted in nihilistic resentment at the vitality of other, stronger modes of living. It argues that this challenge must be taken seriously, and that the best way to do this is to make it clear that morality has as its fundamental basis a responsiveness to the value of human life; hence it is Nietzsche’s ethics that should be called nihilistic. The rest of part two examines the possibility of answering Nietzsche’s challenge by demonstrating a necessary connection between human selfhood and the acknowledgement of the dignity of human beings. Here I criticise Christine Korsgaard’s arguments and consider Charles Taylor’s more promising approach to the self. Part three turns towards pragmatism, and in so doing gives up on the attempt to show that morality is somehow necessary for all human beings. Nietzsche’s challenge is answered more subtly: an empirically backed theory of human selfhood explains the point of morality in terms of our basic need for recognition. I complete the reconstruction of morality by reinterpreting the dignity of human beings in a naturalistic way and adopting a conception of moral rules that is informed by Jürgen Habermas’ discourse ethics

Health Inequities

This chapter provides a critical overview of the empirical and normative literature on health inequalities

On the value of the intellectual commons

Philosophers have so far contributed little to these debates on the optimal regulation of ownership of intellectual property (IP). This chapter analyses what contribution philosophy can expect to make. I begin by distinguishing two tasks that philosophy can attempt when it comes to the optimal regulation of IP: first, philosophers can devise a high level regulatory model for IP, explaining how, for example the ontology of ideas makes a difference to how we should regulate them, and what the overall goals are that we should have in an IP policy. Second, philosophers can attempt to make cogent and concrete policy suggestions on the basis of such a high level regulatory model. I argue that it is often extremely difficult to draw cogent and concrete policy proposals from even extremely good moral and political philosophy; and given the paucity of philosophical theorising so far about IP, it would be especially ambitious to expect philosophers now to construct theories which will have concrete and cogent policy implications. Hence this chapter focuses mostly on the first task

Nietzsche and Equality

Book description: The essays in this anthology are versions of papers originally presented at the 'Friedrich Nietzsche and Ethics' Conference conveyed by the Nietzsche Society in 2004 at the University of Sussex, Brighton, UK. Contributors are respected Nietzsche scholars from around the globe and their essays cover the full range of Nietzsche's moral thinking. They include papers on evolution and development, eudaemonia, art and morality, agon and transvaluation, will to power, as well as free will and genuine selfhood, immoralism, equality, sexual ethics, and the value of pity and compassion. These topics reflect the continuing and ever increasing interest in and relevance of Nietzsche's moral thinking and confirm Nietzsche's status as a moral philosopher of great importance

Freedom of Information and Research Data

Research data produced in both universities and the NHS are subject to the Freedom of Information Act 2000. This article examines the practical and ethical implications of freedom of information for research data, arguing that increased openness is both here to stay and is ethically justifiable. Researchers need to learn how best to cope with this

The ethics of disease eradication

This paper provides an examination of the ethics of disease eradication policies. It examines three arguments that have been advanced for thinking that eradication is in some way ethically exceptional as a policy goal. These are (1) global eradication has symbolic importance, (2) disease eradication is a global public good and (3) disease eradication is a form of rescue. It argues that none of these provides a good reason to think that individuals have special duties to facilitate eradication campaigns, or that public health authorities have special permissions to pursue them. But the fact that these arguments fail does not entail that global disease eradication is ethically problematic, or that it should not be undertaken. Global eradication of a disease, if successful, is a way of providing an enormous health benefit that stretches far into the future. There is no need to reach for the idea that there is a special duty to eradicate disease; the same considerations that are in play in ordinary public health policy – of reducing the burden of disease equitably and efficiently – suffice to make global disease eradication a compelling goal where doing so is feasible

Public Reasoning and Health-Care Priority Setting: The Case of NICE

Health systems that aim to secure universal patient access through a scheme of prepayments—whether through taxes, social insurance, or a combination of the two—need to make decisions on the scope of coverage that they guarantee: such tasks often falling to a priority-setting agency. This article analyzes the decision-making processes at one such agency in particular—the UK’s National Institute for Health and Care Excellence (NICE)—and appraises their ethical justifiability. In particular, we consider the extent to which NICE’s model can be justified on the basis of Rawls’s conception of “reasonableness.” This test shares certain features with the well-known Accountability for Reasonableness (AfR) model but also offers an alternative to it, being concerned with how far the values used by priority-setting agencies such as NICE meet substantive conditions of reasonableness irrespective of their procedural virtues. We find that while there are areas in which NICE’s processes may be improved, NICE’s overall approach to evaluating health technologies and setting priorities for health-care coverage is a reasonable one, making it an exemplar for other health-care systems facing similar coverage dilemmas. In so doing we offer both a framework for analysing the ethical justifiability of NICE’s processes and one that might be used to evaluate others