From Justice to Protection: A Proposal for Public Health Bioethics

117 Pages·2012·0.76 MB·English

by  Miguel Kottow (auth.)

SpringerBriefs in Public Health
For further volumes:
http://www.springer.com/series/10138

Miguel Kottow
From Justice to Protection
A Proposal for Public Health Bioethics
Miguel Kottow
Public Health School
Faculty of Medicine
Universidad de Chile
Universidad Diego Portales
Santiago, Chile
[email protected]
ISSN 2192-3698 e-ISSN 2192-3701
ISBN 978-1-4614-2025-5 e-ISBN 978-1-4614-2026-2
DOI 10.1007/978-1-4614-2026-2
Springer New York Dordrecht Heidelberg London
Library of Congress Control Number: 2011943293
© Miguel Kottow 2012
All rights reserved. This work may not be translated or copied in whole or in part without the written
permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York,
NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in
connection with any form of information storage and retrieval, electronic adaptation, computer software,
or by similar or dissimilar methodology now known or hereafter developed is forbidden.
The use in this publication of trade names, trademarks, service marks, and similar terms, even if they
are not identifi ed as such, is not to be taken as an expression of opinion as to whether or not they are
subject to proprietary rights.
While the advice and information in this book are believed to be true and accurate at the date of going to
press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any
errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect
to the material contained herein.
Printed on acid-free paper
Springer is part of Springer Science+Business Media (www.springer.com)
Contents

1 On Justice and Health Inequities.......................................................... 1
Social Justice ............................................................................................ 2
Globalization ............................................................................................ 3
Global Ethics ............................................................................................ 5
Inequality and Health ............................................................................... 5
Public Health as Social Practice .............................................................. 7
Historical Demographic and Epidemiological Transitions ...................... 8
References ................................................................................................ 10
2 Rights and Duties, Needs, and Merits .................................................. 13
Justice Based on Human Rights ............................................................... 13
Facing Social Justice ................................................................................ 15
Merit and Luck Egalitarianism ................................................................ 15
Need ......................................................................................................... 17
Poverty ..................................................................................................... 19
Primary Goods ......................................................................................... 20
References ................................................................................................ 21
3 Public Health Transitions and the “New Public Health” ................... 23
The Transition from Public to Private Health Care ................................. 24
The “New Public Health” ........................................................................ 25
Internalization of Risk Factors ................................................................. 26
Redesigning the Public Health Agenda .................................................... 28
References ................................................................................................ 30
4 Bioethics in Public Health ..................................................................... 33
Autonomy ................................................................................................ 34
Benefi cence and Avoidance of Harm ....................................................... 35
Justice ....................................................................................................... 35
Beyond Principles .................................................................................... 36
Expanding the Bioethics Agenda ............................................................. 37
Responsibility .......................................................................................... 37
v
vi Contents
Prevention ................................................................................................ 39
Prevention Might be Overrated ................................................................ 40
Precaution ................................................................................................ 41
References ................................................................................................ 43
5 Ethics of Protection I: Theoretical Fundaments ................................. 45
Roots of Protection .................................................................................. 46
Power and Protection ............................................................................... 49
Ethics of Care ........................................................................................... 50
Paternalism ............................................................................................... 50
Protectionism ........................................................................................... 52
References ................................................................................................ 54
6 Ethics of Protection II: Basic Outline .................................................. 55
The Many Faces of Protection ................................................................. 56
Organic Needs .......................................................................................... 57
Empowerment Needs ............................................................................... 57
Social Needs ............................................................................................. 58
Distance .................................................................................................... 58
References ................................................................................................ 60
7 Protective Bioethics ................................................................................ 63
Interpersonal Protection ........................................................................... 65
Collective Protection in Public Health ..................................................... 67
References ................................................................................................ 69
8 Health Care Strategies ........................................................................... 71
Defi ning Health ........................................................................................ 71
Prevention and Precaution ....................................................................... 73
Health Promotion ..................................................................................... 75
Screening .................................................................................................. 78
References ................................................................................................ 81
9 Public Health and Medical Care. .......................................................... 83
Right to Health[care] ................................................................................ 84
Allocation of Scarce Medical Resources ................................................. 87
Priority of Basic Medical Needs .............................................................. 89
References ................................................................................................ 90
10 Ethics and Epidemiology ....................................................................... 93
Epidemiology as Science ......................................................................... 94
The Ethical Issues .................................................................................... 94
The Question of Relevance ...................................................................... 96
Translational Epidemiology ..................................................................... 97
References ................................................................................................ 98
Contents vii
11 Integrating Bioethics in Public Health ................................................. 101
Quandaries of Globalism ......................................................................... 102
Perils of Naturalism ................................................................................. 103
Public Health and Democracy ................................................................. 104
Outlook .................................................................................................... 106
References ................................................................................................ 107

Chapter 1
On Justice and Health Inequities
Abstract Globalized integration in trade and fi nances has required political
adjustments that drive traditional public services to become commodities subject to
market conditions. Most nations have reduced their commitments to provide publicly
funded health, education, and social securities, all of which are being progressively
privatized. This trend has deepened the gap between rich and poor, leading to
increasing social and health inequalities that are impervious to traditional public
health policies. Summit meetings and international declarations have acknowledged
the need to fund external aid to underdeveloped populations, academia lavishly
proposing global justice and health equity based on vaguely conceived pleas for
solidarity and fraternity. The appealing ideas of global ethics have clashed with
economic realities— Realpolitik— as international aid dwindles beyond expectations
and promises, while theoretical schemes are relegated to the realm of utopia.
Health and health care gradients and disparities are on the rise, fueled by an epi-
demiological turn from infectious to chronic degenerative diseases that are associ-
ated with socioeconomic determinants and aggravated by man-made risks, such as
accidents, ecological deterioration, violence, health disrupting life styles, and
unwholesome individual behavior. The reassessment of cultural and personal values
indicates the need for applied ethical perspectives to become incorporated into the
deliberations of public policies, thus bringing to the forefront the development of
bioethics in public health.
Keywords Bioethics • Epidemiological transition • Health inequities • Justice
• Public health • Socioeconomic determinants
M. Kottow, From Justice to Protection: A Proposal for Public Health Bioethics, 1
SpringerBriefs in Public Health 1, DOI 10.1007/978-1-4614-2026-2_1,
© Miguel Kottow 2012