ABSTRACT As bioethics emerged in the 1960s and 1970s and began to have enormous impacts on the practice of medicine and research – fuelled, by broad socio‐political changes that gave rise to the struggle of women, African Americans, gay men and lesbians, and the antiauthoritarian impulse that characterised the New Left in democratic capitalist societies – little attention was given to the question of the ethics of public health. This was all the more striking since the core values and practices (...) of public health, often entailing the subordination of the individual for the common good, seemed opposed to the ideological impulses of bioethics. Of what relevance is autonomy‐focused bioethics for public health, with its mix of justifications including those that are either implicitly or explicitly paternalistic or that seek to impose strictures on individuals and communities in the name of collective welfare? To examine the deep divide between the central commitments of bioethics and the values that animate the practice of public health, we focus on a series of controversies implicating the concepts of privacy, liberty, and paternalism. Recognising the role of moral values in decision‐making was a signal contribution of bioethics in its formative period. Over the past three decades a broad array of perspectives emerged under the rubric of bioethics but individualism remains central. As we commence the process of shaping an ethics of public health, it is clear that bioethics is the wrong place to start when thinking about the balances required in defence of the public's health. (shrink)

Although unprecedented in scope and beyond all our life experiences, sweeping social distancing measures are not without historical precedent. Historically, racism, stigma, and discrimination resul...

In 2012, New York City Mayor Michael Bloomberg proposed capping the size of sugary beverages that could be sold in the city’s restaurants, sporting and entertainment facilities and food carts. After a lawsuit and multiple appeals, the proposal died in June 2014, deemed an unconstitutional overreach. In dissecting the saga of the proposed soda cap, we highlight both the political perils of certain anti-obesity efforts and, more broadly, the challenges to public health when issues of consumer choice and the threat (...) of paternalism are involved. (shrink)

It is one of the remarkable and significant consequence of the AIDS epidemic that out of the context of enormous suffering and death there emerged a forceful set of ideas linking the domains of health and human rights. At first, the effort centered on the observation that protecting individuals from discrimination and unwarranted intrusions on liberty were, contrary to previous epidemics, crucial to protecting the public health and interrupting the spread of HIV But in fairly short order, the scope of (...) the health and human rights perspective expanded dramatically to focus on the ways in which the most fundamental social arrangements rendered individuals and communities vulnerable to HIV Racial and ethnic minorities, those who were marginalized, and women were at risk because of their subordinate status. In the face of such an understanding, nothing short of social change could be adequate to the challenge posed by the AIDS epidemic. (shrink)

It is one of the remarkable and significant consequence of the AIDS epidemic that out of the context of enormous suffering and death there emerged a forceful set of ideas linking the domains of health and human rights. At first, the effort centered on the observation that protecting individuals from discrimination and unwarranted intrusions on liberty were, contrary to previous epidemics, crucial to protecting the public health and interrupting the spread of HIV But in fairly short order, the scope of (...) the health and human rights perspective expanded dramatically to focus on the ways in which the most fundamental social arrangements rendered individuals and communities vulnerable to HIV Racial and ethnic minorities, those who were marginalized, and women were at risk because of their subordinate status. In the face of such an understanding, nothing short of social change could be adequate to the challenge posed by the AIDS epidemic. (shrink)

In 2009, in a provocative article in the Lancet , Granich et al . proposed a radical public health intervention to address the vast human toll exacted by the HIV epidemic in regions with generalized epidemics where millions are infected. The proposal, based on modeling, suggested that universal screening for HIV and immediate treatment for all found to be infected, regardless of immune status, could ultimately reverse an epidemiological course that has appeared resistant to efforts at prevention.

Fairchild, Center for the History and Ethics of Public Health in the Department of Sociomedical Sciences at Columbia University's Mailman School of Public Health Abstract Surveillance is a cornerstone of public health. It permits us to recognize disease outbreaks, to track the incidence and prevalence of threats to public health, and to monitor the effectiveness of our interventions. But surveillance also challenges our understandings of the significance and role of privacy in a liberal democracy. In this paper we trace the (...) century-long history of public health surveillance in the United States situating that history in the context of the broad social, political, and ideological forces that have shaped our conceptions of privacy. Although we focus here on the United States, the debates over privacy that unfolded in the 1960s were repeated in many European nations. The themes we explore here, then, provide a framework for examining the relationship between privacy and public health in other contexts. CiteULike Connotea Del.icio.us What's this? (shrink)

What justified the Center for Disease Control's1999 determination to require HIV casereporting? Why were names necessary? Why didopponents view the reporting of names with suchalarm? This paper retells the history of theencounters over HIV reporting that had occurredsince the mid 1980s. In placing HIV reportingwithin a larger context, however, we understandthe clash between privacy and public healthnecessity as a complex issue, both inhistorical and contemporary practice. Byunderscoring the similarities and differenceswith the histories of surveillance for otherinfectious diseases, vaccination, occupationaldiseases, cancer, (...) and birth defects, and HIVreporting internationally, we can betterunderstand the implications of the HIV debatefor an ethics of surveillance more generally. (shrink)

Surveillance serves as the eyes of public health. It has provided the foundation for planning, intervention, and disease prevention and has been critical for epidemiology research into patterns of morbidity and mortality for a wide variety of disease and conditions. Registries have been essential for tracking individuals and their conditions over time. Surveillance has also served to trigger the imposition of public health control measures, such as contact tracing, mandatory treatment, and quarantine. The threat of such intervention and long-term monitoring (...) has provoked alarm and rendered surveillance suspect for those concerned about the unwarranted exercise of state authority in the name of public health. Thus the history of surveillance has been bounded by promise of disease control and a specter of intrusion. In this article we address the tension between the public's need for knowledge as a foundation for rational policy-making and the centrality of norms of privacy for democratic societies. (shrink)

Can world peace come about through a world federation of governments? Is growing agreement and appreciation for, throughout the world, the doctrine of equal human rights inevitable? Such questions are raised by Mortimer Adler in How to Think about War and Peace. Adler argues in this book that both are possible, and in doing so he argues that the insights of liberal contract thinkers, particularly Immanuel Kant, are essentially true. Kant argues that each person has the capacity to discover within (...) himself the foundation for human rights because they are self-evident. It follows that over time inequalities and prejudices will disappear, and people will gain the freedom to advance the cause of peace. About this account of the possibility of world peace I ask the question: is it indeed reasonable? For if it is reasonable, it is not reasonable for the reasons that would have been advanced by Aristotle or Plato or their medieval followers. In older political philosophy it is agreement about the unchanging truth of things that can bring peace. To seek the unchanging truth of things, philosophical speculation about God and things divine, is the highest human activity. It is that end to which life in this world is directed, and upon which human flourishing depends. Freedom depends upon our openness to unchanging eternal truth, even more than self-evident rights; the exercise of speculative reasoning allows for political discourse and an open society. (shrink)

I Several years ago, when the Carter administration announced that it would support congressional action to end the public fund ing of abortions, the President was asked at a press conference whether he thought that such a policy was unfair; he responded, "Life is unfair." His remarks provoked a storm of controversy. For other than those who, for principled reasons, opposed abor tion on any grounds, it seemed that the President's comments were cruel, violating what was thought to be an (...) American com mitment to providing equal access to health services to all citi zens, regardless of their capacity to pay. Those sentiments had, in fact, been reflected in public opinion polls that had, for at least three decades, indicated that Americans supported the propo sition that the government should guarantee health care to all. Ultimately, those beliefs had been translated into the oft-ex 1 pressed political demand for a one-class system of health care. This commitment to equality is rather remarkable. American society evidences a striking willingness to tolerate vast inequal ities with regard to income and wealth. While it guarantees ed ucation to all children, there is not even a pretense that the children of the wealthy and the children of the poor ought to get precisely the same kind of schooling. While some commitment 'Hazel Erskine. "The Polls: Health Insurance," Public Opinion Quarterly, XXXIX (Spring, 1975), 128-143. (shrink)

RésuméIl y a, dans la notion de dialectique moderne, deux perspectives de l'évolution intellectuelle: l'intelligence peut n'ětre encore que la pointe extrěme de l'adaptation biologique ou elle peut ětre déjà l'expression de la raison. C'est ce caractère ouvert des dialectiques scientifiques que nous retrouvons dans les interprétations étudiées ici: le pancalisme de Baldwin, la pensée sans images de Binet, l'interprétation de Janet et celle de Piaget, qui contribuent à enrichir la notion de genèse de l'intelligence et à en faire saisir (...) l'évolution.ZusammenfassungDie geistige Entwicklung wird in der modernen Dialektik aus zwei Gesichtspunkten erfasst, und zwar mag die Intelligenz wohl nur noch das äusserste Ende der biologischen Anpassung oder schon der Ausdruck der Vernunft sein. Das Offene eben der wissenschaftlichen Dialektiken finden wir in den hier erörterten Deutungen wieder, im Baldwinschen Pancalismus, im Denken ohne Bilder von Binet, in den Deutungen von Janet und von Piaget, die dazu beitragen, den Begriff von der Entstehungsgeschichte der Intelligenz zu bereichern und deren Evolution verständlich zu machen.There are two prospects of intellectual evolution in the notion of dialectics: intelligence can either be the ultimate point of biological adaptation or it can already be the expression of reason. Within this open characteristics of scientific dialectics are to be found the interpretations studied here: Baldwin's pancalism, Binet's » thought without image «, Janet's and Piaget's interpretations which help to enrich the knowledge of the genesis of intelligence and its evolution. (shrink)

Cet ouvrage est une réédition numérique d’un livre paru au XXe siècle, désormais indisponible dans son format d’origine.