Mahmoud F. Fathalla
There is an ethical imperative to take public health action to eliminate the global problem of unsafe abortion. The moral obligation is dictated by the magnitude of the problem, the health inequities and social injustices that result from lack of access to safe abortion, the voices of women calling for action, and an international consensus recognizing unsafe abortion as a global health problem. The availability of public health interventions and the cost savings associated with fewer abortion complications reinforce the obligation to address unsafe abortion. Public health actions include reducing the need for abortion through family planning, providing safe abortion to the full extent of the law, managing abortion complications, and providing post-abortion care. These actions intersect with morality, religion, law, justice, and human rights. The public health community has a collective social and ethical responsibility to stand beside and behind women as they claim their human right to health.
Absolutism is a nineteenth-century term designed precisely to address the mismatch between doctrine and power. The intellectual resources of absolutism were far older than the Renaissance and Reformation. The absolutism of monarchs was a contingent and temporary corollary of the principal juridical development of the early modern period: the emergence of the concept of sovereignty. Absolute monarchy was a free rider on a concept that would later unseat it. Theorists of absolute sovereignty drew heavily on Roman law, and often invoked the idea of the translatio imperii, the inheritance by modern monarchies of Roman imperial authority. The sovereignty of kings, seeking to trump the divine imperium of the papacy, masqueraded its jurisprudence as the divinity of kings. The “divine right of kings” was a theological meditation on a juridical concept, not a species of mysticism, and rarely did absolutists endow monarchs with magical or sacerdotal attributes. Absolutism conspicuously appropriated religious form when expressed as a theory of obedience. Absolutist theory offered an account of the origins of civil authority.
Anne Drapkin Lyerly, Elana Jaffe, and Margaret Olivia Little
Advancing fair access to evidence-based pregnancy-related services is a critical public health priority. It is widely recognized that there are inequalities in lifesaving interventions. This chapter however addresses issues raised by services whose value or utility are contested. Using illustrative examples of prenatal genetic testing and modes of childbirth, the chapter highlights the ways in which issues of access are complicated by social and cultural ideas about what is valued; discusses contested questions about what is ethically responsible or required of patients, providers, and public health systems in these reproductive health contexts; and addresses areas of needed research and further ethical analysis. It concludes that issues of access in pregnancy-related care must attend both to broad issues of justice and access and to particular ways that pregnancy services are valued, debated, and made available to women who might—or might not—benefit from them.
James R. Otteson
Richard Thaler and Cass Sunstein argue for “libertarian paternalism,” defined as the strategy to devise policy that will “maintain or increase freedom of choice” and at the same time “influence people’s behavior in order to make their lives longer, healthier, and better”. These two goals are often in conflict, and striking the right balance between them has proved difficult in both theory and practice. Where does Adam Smith fall in this debate? This chapter argues that Smith developed his own version of “libertarian paternalism.” It differs in important ways from that of Thaler and Sunstein, but it shares with them an attempt to balance respect for individual autonomy with a desire to help people lead better lives. Smith’s position accommodates the importance of both liberty and paternalism in enabling individuals to construct lives worth living, while avoiding some of the problems that have beset more recent versions of libertarian paternalism.
This chapter discusses key issues and questions about aesthetic experience and valuing of natural objects, processes, and phenomena. It begins by exploring the character of environmental, multisensory aesthetic appreciation and then examines the central debate between “scientific cognitivism” and “noncognitivism” in contemporary environmental aesthetics. In assessing this debate and the place of knowledge, imagination, and emotion in aesthetic valuing, it is argued that non-cognitive approaches have the advantage of supporting a critical pluralism that recognizes the variety and breadth of aesthetic engagement with nature. Interactions between aesthetic and ethical values are also discussed, especially with respect to their role in philosophical positions such as “aesthetic preservationism” and the call for developing aesthetic theories that are consistent with environmentalism.
James P. Sterba
Diversity instead of race-based affirmative action developed in the United States from the Regents of the University of California v. Bakke decision in 1978 to the present. There have been both objections to this form of affirmative action and defenses of it. Fisher v. University of Texas could decide the future of all race-based affirmative action in the United States. Yet however the Fisher case is decided, there is a form of non-race-based affirmative action that all could find to be morally preferable for the future. A diversity affirmative action program could be designed to look for students who either have experienced racial discrimination themselves or who understand well, in some other way, how racism harms people in the United States, and thus are able to authoritatively and effectively speak about it in an educational context.
This chapter examines three primary public health goals relating to elderly populations: promoting healthy aging (including aging in place), reducing health inequities, and extending life spans. It then considers the ways in which programs or policies to advance population-wide goals are challenged to meet ethical responsibilities to protect older adults from harm, respect their autonomy and dignity, and treat them fairly or justly when resources are limited. Lastly, by looking at a difficult situation commonly faced in hospitals—the discharge of an elderly patient who may not be able to safely return home—the chapter introduces questions about the relationship between public health ethics, clinical ethics, and social justice, and about the future role of public health as a field of inquiry and action.
This chapter examines ethical principles that guide public health intervention to reduce the harms of alcohol and other drugs, including justice-based concerns regarding intervention. While many egalitarian moral theories support public health measures to reduce these harms, and thereby protect individual capability and opportunity, there are opposing arguments to limit public health intervention based on either individual liberty or personal responsibility. The chapter also reviews ethical issues related to prevention, treatment, harm reduction, and decriminalization/legalization. Prevention through education is politically appealing, but is not always evidence-based and can be stigmatizing. Treatment can be highly cost-effective, but some approaches are controversial, such as legally coerced treatment. Harm reduction approaches, such as needle exchange, can reduce many of the negative health consequences of alcohol and drug use, but they require a more direct government role in illicit behaviors. Marijuana legalization is a growing movement in the United States, but it poses complex regulatory challenges.
Anarchism rejects the state as an inherently despotic institution that must be abolished in order for human nature to flower. This does not mean the absence of social order, however, for anarchism also contains a positive vision of the kind of community it expects to arise when political authority is eliminated. Although it shares liberalism's commitment to individual autonomy and Marxism's commitment to social justice, anarchism claims that it can implement those principles more fully and effectively without utilizing the mechanism of the state. Anarchism as a secular political philosophy originated as a product of the Enlightenment and the French Revolution, and anarchist thought was the cumulative product of a number of different individuals in different countries who elaborated its basic principles. This article examines the views of several thinkers on anarchism, including William Godwin, Pierre-Joseph Proudhon, Michael Bakunin, and Prince Peter Kropotkin. It also considers the link between anarchism and terrorism.
In the ancient world, the idea that killing animals for food is wrong arose mainly from belief in a deep continuity between the animal and human psyche. The underlying thought is that the victimization of an animal is sinful and dehumanizing. Among the Greeks, orphic ritual and mysticism mixed with philosophy prescribe a vegetarian diet as a condition of self-purification. Perhaps the major extant work on vegetarianism dating from classical antiquity is On Abstinence from Animal Flesh by the neo-Platonist Porphyry, the student and biographer of Plotinus, himself a vegetarian. Peter Singer's immensely popular book Animal Liberation (1975) almost immediately generated a new movement for animal rights as distinct from a program limited to animal welfare, animal protection, and prevention of cruelty. This article explores the link between animal rights and political theory, focusing on the views of such thinkers as John Wesley, Bernard Mandeville, Francis Hutcheson, David Hume, Jean-Jacques Rousseau, Jeremy Bentham, Tom Regan, Immanuel Kant, Christine M. Korsgaard, and Charles Hartshorne.