Paternalism, Autonomy, and the Common Good

2021 ◽  
pp. 89-109
Author(s):  
James Wilson

Public health policies are often accused of being paternalistic, or to show the ‘Nanny State’ in action. This chapter argues that complaints about paternalism in public health policy are, for a variety of reasons, much less convincing than is often thought. First, for conceptual reasons, it is difficult to specify what it would be for a policy to be paternalistic. Second, two of the elements that make paternalism problematic at an individual level—interference with liberty and lack of individual consent—are endemic to public policy contexts in general and so cannot be used to support the claim that paternalism in particular is wrong. The chapter concludes that instead of debating whether a given policy is paternalistic, it would be better to ask whether the infringements of liberty it contains are justifiable, without placing any weight on whether or not those infringements of liberty are paternalistic.

2021 ◽  
pp. 323-338
Author(s):  
John Powles ◽  
Hebe Gouda

Public health policies might thus be thought of as the policies that guide these ‘organized efforts’ to protect and improve health. The scope of such policies depends a good deal, however, on what is considered to be entailed by ‘organized efforts’. and on how centrally ‘organized efforts’ are understood to be related to efforts that are more decentralized, more informal, less organized, perhaps even ‘spontaneous’. The relative importance and legitimacy of centralized versus decentralized uses of knowledge in protecting and enhancing health is a common underlying theme in discussion of public health policy. This chapter discusses public health policy, and differences in outcomes, across different developed countries.


1995 ◽  
Vol 27 (3) ◽  
pp. 551-567 ◽  
Author(s):  
Carl J. Murdock

AbstractThis study of public health policy in Chile uncovers some of the social tensions in that country during the 1880s, and illustrates the fragmentation of the Chilean elite prior to the Revolution of 1891. The Chilean government's controversial and contested public health policies implied the increasing bureaucratic organisation and regulation of society. The justifications offered for these policies by central government officials reveal both the deep roots in Chilean politics of a powerful Executive, and the early linkage between the ‘scientific discourses’ of medical professionals and the bureaucratic centralisation of state power.


2019 ◽  
Author(s):  
Annemarie Kinzelbach

Recent historiographical studies of the Holy Roman Empire reveal that policy focused on defining and redefining the relationship between governors and citizens, largely through negotiating practices. Historians have applied these discoveries in limited ways when discussing public health policies in German-speaking areas, ignoring questions of compliance, resistance, or enforcement. Some lacunae result from archival losses, but survivals enable us to fill many gaps. In this chapter, relevant premodern statutes are first identified. Secondly, textual analysis of manifold sources uncovers implicit associations (for example, parallels between dirt and prostitution), while highlighting explicit relationships between communal health and such general issues as religion, morality, and the common good. Negotiation practices are unveiled, for instance, in modifications to statutes and regulations. Thirdly, contemporary chronicles, diaries, accounts, council minutes and administrative documents are examined for information on implementation of laws and ordinances.


2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
W Van Hoof ◽  
C Mayeur

Abstract The time when public health policies could be based solely on expert opinion has gone. Public opinion has a real impact on the effectiveness of public health policy. However, for complex issues such as vaccination, screening, GMO’s, privacy and data governance, public opinion is divided. How to integrate divided public opinions into a well-structured health policy? In Belgium, as in many other countries, policy makers have started to turn to deliberative processes to guide policy making with citizen involvement, especially in ethically contentious areas. Deliberative processes aim to involve citizens in policy making in a setting where individual opinions and interests are weighed honestly and fairly, so that through well informed deliberation common ground can emerge. Participants are informed by a neutral information package, a variety of experts and facilitated discussions. In a very transparent way, these positions are molded into tailored policy inputs. In Belgium, such initiatives have recently been organized on biobanking, genomics, e-health, reimbursement policies and more. In France, the government is obliged by law to organize a comprehensive deliberative public consultation on bioethical issues every seven years. Especially in areas that require a large degree of trust, a deliberative approach ensures policies that can be supported by people with diverse views. They offer a viable alternative to traditional models of power and conflict that is more suitable to governance in 21st century democracies. They allow citizens to make a meaningful contribution to topics they may not have been familiar with beforehand, but that do touch on their private lives and interests. The most recent Belgian initiative resulted in nine concrete policy inputs for the implementation of genomics in health care, presented directly by the citizens to the Minister of Public Health. The French initiative is the basis for the current review of the law on bioethics in parliament. Key messages Public health issues touch the interests of all citizens: citizen deliberation should be regarded as an important input for public health policies. A deliberative approach enhances public trust, especially in areas of social or ethical contention.


2012 ◽  
Vol 41 (2) ◽  
pp. 391-408 ◽  
Author(s):  
ROB BAGGOTT

AbstractLike many countries, England has introduced a range of policies and strategies on public health since the early 1990s. Using concepts drawn from the policy success and failure literature, this article concludes that recent governments in England achieved only ‘precarious success’ in McConnell's typology. It demonstrates, with wider significance, that success or failure is not merely about policy achievement in programme terms, but that policy processes and the political dimensions of policy must be included in any evaluation. It also highlights the adversarial nature of public health policy, the subjectivity of judgments about effectiveness and the political problems this creates for government. The article pinpoints the relevance of public health policies for judgements about government competence, trustworthiness and accountability. It argues that failures of public health policy, including poor evaluation and failures to learn from experience, may be more comprehensible by adopting a political analysis of public policy making in this field.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Mialon ◽  
E Perez ◽  
C Corvalan ◽  
C Monteiro ◽  
P Jaime ◽  
...  

Abstract One of the key barriers to the development of public health policies, such as restrictions on marketing of unhealthy foods to children, is the influence of corporations, also known as corporate political activity' (CPA). This project aimed to identify the CPA of the food industry in Brazil, Colombia and Chile, over a 2-year period. This research consisted of a document analysis of publicly available information triangulated with interviews. It contributed to, and was based on methods developed by INFORMAS (International Network for Food and Obesity / non-communicable Diseases Research, Monitoring and Action Support), which aims to monitor food environments. In all three countries, the food industry lobbied against public health policies and had direct access to high ranking officials and policy makers. It also shifted the blame away from its products in the obesity and non-communicable diseases epidemic onto individuals and their lack of education. In Brazil, the food industry was active against a new front-of-pack labeling, setting up its own website to promote an alternative model and self-regulation. In Colombia, the food industry captured the media and had strong ties with the government, including through nutrition programmes. Public health advocates felt unsafe when speaking against the industry or its products. In Chile, despite advances with the introduction of public health policies to limit the sales and marketing of unhealthy products, the food industry, including the sweeteners industry, which was not affected by the recent legislation, was still influencing policy, research and practice. Food industry actors, including local companies and transnationals, used several CPA strategies in Latin America to try and influence public health policy, research and practice. It is urgent that policy makers, academics and other individuals in public health are aware of these practices and equipped with solutions to address undue influence by the food industry Key messages In Latin America, the food industry used several CPA practices, which collectively could have a negative influence on public health policy, research and practice. These practices could delay efforts to protect and promote public health in the region.


2016 ◽  
Vol 85 (2) ◽  
pp. 50-52 ◽  
Author(s):  
Matthew Greenacre

Paternalism is defined as an action that infringes a person’s liberty and is performed without their consent, but is intended to improve a person’s welfare. As such, many public health policies are criticized as being paternalistic because they attempt to influence citizens’ behaviours to prevent disease or injury. Therefore, public health advocates ought to be aware of what justifies paternalism. Arguments based on the harm principle are the strongest defense of paternalistic policies in Western culture, but reinforcing an individual’s integrity and improving social welfare may also be considered sufficient reasons. In practice, what is considered sufficient reason for paternalism depends upon the culture of the affected society. Collectivist cultures are willing to accept a paternalistic policy in exchange for a better quality of life for their whole community, but individualist cultures are very averse to such a trade. This article provides examples of how these principles arise in the debate over implementing anti-obesity legislation. Advocates must recognize paternalism and know when it is acceptable in order to defend public health policy from that common criticism.


2002 ◽  
Vol 30 (2) ◽  
pp. 224-238 ◽  
Author(s):  
Peter D. Jacobson ◽  
Soheil Soliman

An ongoing debate among legal scholars and public health advocates is the role of litigation in shaping public policy. For the most part, the debate has been waged at a conceptual level, with opponents and proponents arguing within fairly well-defined boundaries. The debate has been based either on speculation of what litigation could achieve or on ideological grounds as to why litigation should or should not be used this way. With the exception of Rosenberg's study of how litigation shaped policy in civil rights, abortion, and environmental matters, there is almost no empirical support for either position.In recent years, the most ardent proponents of litigation as public policy have been public health advocates. Perhaps out of frustration with the inability to achieve desired public health goals through the legislative branch of government, public health advocates have pursued litigation as an alternative strategy. Beginning with tobacco class action litigation in the early 1990s and continuing with litigation against gun manufacturers at the end of that decade, public health advocates have waged a veritable litigation assault aimed at changing how public health policy is formed.


Author(s):  
Adnan A. Hyder ◽  
David M. Bishai

An understanding of what influences policy decisions, what determines investments for specific public health interventions, and how agreements are made regarding new programs in public health is crucial for helping navigate the ethical implications of public health programs and interventions. This chapter provides an overview of the Public Health Policy and Politics section of The Oxford Handbook of Public Health Ethics. The section’s overall goal is to highlight ethical issues emerging from the work in, and study of, politics and policy development in public health, both within countries and globally. The chapters in this section analyze a set of ethical issues related to politics and public health policies, interventions, and programs, and emphasize the importance of communication among various disciplines, such as bioethics, political science, and development studies.


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