The right to public health

Abstract

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' approach with what is best about a standard public health approach. It develops a positive case for state action to promote and protect 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.

Should US Physicians Support the Decriminalization of Commercial Sex?

“…Although paternalistic approaches in matters of public health are always controversial, it has been argued that "too little state intervention in the cause of improving population health can violate individuals' rights, just as too much can" [70]. On the question of decriminalizing the form of commercial sex known as prostitution in the US, the potential harms to individuals and the public must be considered as carefully as the benefits of the expansion of individuals' rights.…”

The ethics of new technologies to track drug adherence

“…But autonomy is often much more than simply not interfering in the lives of others and with their choices. 5 To get a fuller sense of autonomy, we ought to consider the importance of making informed choices, how someone becomes autonomous, and how much of what makes people autonomous lies outside their direct control.…”

“…8 Third, how autonomous people are depends greatly on external factors. 5 From obviously important external pressures (e.g., war, famine or being born into wealth) to less obvious and, perhaps somewhat triv-ial, pressures (e.g., the size of soda cups), not merely our choices but how we direct our lives are constantly being shaped by external factors. Concerns about justice can potentially be redescribed as a means of rectifying those social, political and economic factors that are deemed morally wrong and impinge on autonomy.…”

“…Each person benefits from collective public health efforts, including surveillance. 5 The individual-level benefits of surveillance justify those external factors that positively affect autonomy. Better surveillance can help prevent the spread of infectious diseases and can help manage resources in cases of chronic diseases, all of which allows individuals to be more selfdirecting by promoting stewardship and social protections.…”

The obesity epidemic and sugar‐sweetened beverages: a taxing time

“…Individual rights can be equally violated if government fails to take effective and proportionate measures to remove health threats from the environment in the cause of improving population health. 7 Government pays for health services and consequently has a right and duty to address externalities to promote and protect public health. Moreover, government intervention on health risks, including foods, can be justified from an economic perspective when the burden of diseases is mostly paid by society.…”