Ethical Dilemmas in Protecting Susceptible Subpopulations From Environmental Health Risks: Liberty, Utility, Fairness, and Accountability for Reasonableness

Abstract

Various U.S. laws, such as the Clean Air Act and the Food Quality Protection Act, require additional protections for susceptible subpopulations who face greater environmental health risks. The main ethical rationale for providing these protections is to ensure that environmental health risks are distributed fairly. In this article, we (1) consider how several influential theories of justice deal with issues related to the distribution of environmental health risks; (2) show that these theories often fail to provide specific guidance concerning policy choices; and (3) argue that an approach to public decision making known as accountability for reasonableness can complement theories of justice in establishing acceptable environmental health risks for the general population and susceptible subpopulations. Since accountability for reasonableness focuses on the fairness of the decision-making process, not the outcome, it does not guarantee that susceptible subpopulations will receive a maximum level of protection, regardless of costs or other morally relevant considerations.

Precautionary Reasoning

“…While democracy would seem to be the best way of making these kinds of decisions concerning risks, as we shall see in Chapters 2 and 5, it has some problems and limitations that need to be taken into account to ensure that group decisions are fair. One of these is that democracy may not always give adequate consideration to vulnerable or disenfranchised groups (Gutmann and Thompson 2004;Fishkin 2011;Resnik et al 2018). For example, suppose that a few members of mushroom club are more vulnerable to the toxic effects of mushrooms than others.…”

Two unresolved issues in community engagement for field trials of genetically modified mosquitoes

“…Though some scientists and industry leaders may view engagement as important only as a means of obtaining public support for new technologies, engagement has value for its own sake because it facilitates deliberative democracy [6,7,12]. Deliberative democracy is a form of public decision-making that demonstrates respect for human dignity by directly involving citizens in decisionmaking [7,[25][26][27][28][29]. Deliberative democracy also promotes procedural justice 4 because it helps to ensure that disadvantaged and underrepresented populations are included in policy debates, and it helps it minimize the impact of powerful corporations and interest groups on decision-making [7,[25][26][27][28][29].…”

“…Deliberative democracy is a form of public decision-making that demonstrates respect for human dignity by directly involving citizens in decisionmaking [7,[25][26][27][28][29]. Deliberative democracy also promotes procedural justice 4 because it helps to ensure that disadvantaged and underrepresented populations are included in policy debates, and it helps it minimize the impact of powerful corporations and interest groups on decision-making [7,[25][26][27][28][29]. Engagement supports deliberative democracy because it gives citizens from diverse perspectives and backgrounds the opportunity to have meaningful input into government actions (such as legislation and regulatory decisions) that affect their interests [6][7][8].…”

“…If a community decides against a proposed field trial, then another suitable site should be sought. However, justice often involves difficult trade-offs between the interests of groups or individuals and those of society [29,34,37], and since situations may arise in which a community rejects a proposed field trial and suitable alternative sites are not available, it is wise to anticipate such conflicts in advance and be prepared to deal with them in a fair and reasonable way. 5 Engaging the community in an honest, transparent, respectful, and inclusive dialog about the benefits and risks of a proposed field trial allows the community's voice to be heard, even if the interests of society ultimately prevail in some situations.…”

“…Procedural justice refers to fairness in a decision-making process; substantive justice refers to fairness related to the outcome of the process[28,29,42].…”