Public Health Ethics


Medical ethics, as an object of systematic study, was born in the USA at the beginning of the 1960s. For the first forty years or so, medical ethics (and bioethics as the emerging discipline came to be known) largely focused on individual problems in the doctor-patient relationship, and on formulating responses to new technologies such as IVF or genetic engineering. Large-scale ethical questions about the role of governments in protecting the health of their citizens, and the fairness of a world in which some social groups - even within the same city - have markedly longer life expectancies than others were barely considered.

This narrowness of vision has been comprehensively critiqued in the bioethics of the last ten years. It has become increasingly apparent that provision of healthcare is only one of a number of determinants of health. These other determinants include workplace stress, social exclusion, early nurturing environment and the inequality of distribution of income in society. This raises a deep problem for traditional bioethics: if healthcare has only a relatively small effect on health, how can it be justifiable for bioethics to focus only on what happens in healthcare? The result has been a shift of much work in bioethics towards public health ethics: ethical reflection on what governments should and should not do to ensure the health of their citizens.

This shift has been consolidated by the fact that many of the new technologies which have so excited bioethicists – such as gene therapy, “personalised medicine” and synthetic biology – have so far failed to deliver significant health improvements, whilst population level measures such as banning smoking in public places and improving road safety have had very significant effects.

My work

My work in public health ethics examines a number of fundamental questions about the protection and promotion of health. Under what circumstances is it legitimate for  governments to interfere with liberty in order to promote the health of the population? When are inequalities between the health of social groups unfair? Should publicly funded healthcare systems with limited budgets buy hyperexpensive new patented treatments? What duties are there to preserve the effectiveness of antibiotics over time?

Publications on Public Health Ethics (most important works are starred)