Public Health Ethics最新文献

There are two main ways in which a mandatory vaccination policy is often defended-by accusing vaccine refusers of 'free riding', or by appealing to the 'harm principle'. In their recent book, Roland Pierik and Marcel Verweij take the latter approach-an attractive option, as they note, due to the wide acceptance of the harm principle. But in arguing that vaccine refusal should indeed be thought to constitute harm, they end up endorsing a very controversial version of the harm principle, which we should not automatically expect to secure widespread support. Steven Smith suggests that this (common) argumentative strategy amounts to free riding on the reputation of the harm principle, and is an inevitable consequence of invoking the principle as the foundation of an argument. In its most basic form, the principle is hard to resist. But in order to use it to justify a policy, you need to make some assumptions about what constitutes harm, which will lose you supporters along the way. In appealing to the wide appeal of the harm principle, Pierik and Verweij do not adequately recognise the controversial nature of their claims, and thus the need for stronger and more elaborate arguments in their support.

We know that vaccine hesitancy is closely related to distrust in health organisations, pharmaceutical industry or governments (Vuolanto et al. 2024). At the end of the book, I am left with the question what is necessary to bridge the gap of distrust and how this relates to discussions on coercive measures. Intuitively, it seems necessary to understand the different types of distrust non-compliant parent groups have and Pierik and Verweij discuss these in Chapter 3 in order to offer tailored approaches to build trust. In Chapter 9, Pierik and Verweij discuss the lack of trust more specifically, but I question if their approach is well thought through: they are ambivalent on a so-called information deficit perspective on trust, which they reject and also seem to assume at the same time. I will first look at the various sources of distrust that Pierik and Verweij distinguish before I discuss their view on trust and trustworthiness.

In this commentary, I will contend that one of Pierik and Verweij's central arguments for vaccine mandates faces significant obstacles because of their attempt to apply Mill's harm principle. More specifically, they argue that vaccine refusal is harmful because of its relationship to the collective good of herd immunity. I suggest that Pierik and Verweij oscillate between two interpretations of the harm principle: a narrow interpretation and a broad one. The narrow interpretation, however, does not justify mandates because it is implausible that one individual's act of vaccine refusal makes a meaningful difference to whether herd immunity is achieved. The broad interpretation avoids this problem, but it risks abandoning the authors' aspiration to advance a distinctively liberal argument. I conclude that those who wish to defend vaccine mandates by appealing to their role in achieving or maintaining herd immunity face a choice: they need to either (i) find argumentative resources within the liberal tradition that are more promising than the harm principle or (ii) develop defenses that are not liberal but indicate why this does not constitute a problem.

In their recent book, Inducing Immunity (2024), Roland Pierik and Marcel Verweij develop an account of collective immunization according to which liberal-democratic governments are sometimes justified in restricting people's freedom to refuse vaccination. In this commentary, I focus on a specific argument in the book about misinformation, freedom of expression and mandatory vaccination. Pierik and Verweij argue that, when vaccine misinformation threatens vaccination rates, governments-in order to increase or maintain vaccination rates-should consider mandatory vaccination before restricting freedom of expression. I summarize the argument and raise two issues to help advance the debate.

Roland Pierik and Marcel Verweij, in their excellent book Inducing Immunity?, draw a distinction between 'best interest' and 'basic interest' and use such distinction as a criterion for legitimate state interference with parental choices, including in the case of vaccination. While protection of children's basic interests does provide a solid basis for the justification of state intervention in vaccination decisions, I want to offer some considerations and raise some questions about how the distinction between best and basic interest is conceptualized in the book, about some assumption on the relationship between freedom of choice and best interest that that distinction implies, and about some broader implications for discussion of child vaccination. I will conclude by raising a question about the justification for mandating vaccination within Pierik's and Verweij's ethical framework.

In this article we respond to critical comments from colleagues on Inducing Immunity? Justifying Immunization Policies in Times of Vaccine Hesitancy (MITpress, 2024). We explain why we have chosen to focus on John Stuart Mill's harm principle as a basis for developing our argument for mandatory immunisation policies. With help of our critics, we subsequently elaborate on our conception of harm and argue that this is not opening the door to illiberal policies. We discuss the role of coercion and the idea of the 'best-interest of the child', and we further develop our account of trustworthiness of a vaccination policy.

This paper examines the experiences of teachers in Australia during the COVID-19 pandemic from a care ethics perspective. While pandemic preparedness plans prioritised continuity of services and infection control, they failed to anticipate the relational and moral labour required of frontline workers in non-clinical roles. Paradoxically, otherwise prudent and precautionary responses to the risks posed by the pandemic established new barriers to care and human connection and exacerbated existing ones. Drawing on 32 qualitative interviews with teachers, we analyse how they engaged in improvised, context-specific practices of care. We distinguish between care initiated by workers and care requested of them, highlighting asymmetries. We argue that the pandemic exposed and intensified structurally patterned inequities in the distribution and valuation of care work and that existing accounts of care ethics do not sufficiently explain community care performed by teachers. The paper calls for pandemic planners to explicitly anticipate the needs that public health restrictions create and acknowledge and centre care as a communal good. This is because when care is invisible, it is not planned for, acknowledged or supported. Ignoring it exposes persistent institutional failures to recognise and sustain the everyday labour that holds society together in times of crisis.

Humanitarian aid workers face several ethical challenges. They work in resource-limited settings, navigate power imbalances and face obstacles responding to populations affected by crisis. The Covid-19 pandemic added additional layers of challenge in places such as camps for refugees and internally displaced persons. However, the impact of the pandemic in these settings was varied, and in many cases, less than anticipated, raising questions about calibration of Covid-19 prevention and response to local realities. We conducted an exploratory qualitative descriptive study to better understand humanitarian aid workers' experiences in temporary displacement camps in the context of the Covid-19 pandemic. We interviewed 10 humanitarian aid workers with pandemic experience working in the Middle East, Africa, Asia and Europe, among others. Participants described ethical challenges, including implementing proportionate Covid-19 prevention strategies while mitigating harms of this response; navigating an environment with misinformation; responding to expectations of external authorities; fulfilling aid worker obligations amidst a global pandemic; questioning power imbalances within the humanitarian aid organizational hierarchy. Further understanding these ethical challenges may help orient training and policy to support responses to the needs of displaced populations in future public health emergencies, as well as better support humanitarian aid workers in these situations.

This Case for Discussion examines legislative constraints as occupational health hazards that induce moral distress among healthcare professionals (including physicians, nurses, and midwives). Traditionally framed as clinical ethics issues, moral distress emerges as a population-level public health concern when regulatory barriers systematically conflict with clinical judgment. Drawing on empirical evidence from abortion restrictions and European contexts (Italy, France, Spain), the case highlights psychological harms, burnout, and systemic consequences like defensive medicine and workforce emigration. Key normative questions address occupational risk classification, stress assessment tools, prospective legislative impact evaluations, occupational medicine roles, professional associations' advocacy, and institutional obligations balancing conscientious objection with service provision. The analysis reframes moral distress through a public health ethics lens, advocating expanded risk frameworks, organizational support, and policy interventions to protect healthcare workers while advancing population health goals.