Public Health Ethics. Thinking about bioethics, human rights, justice and moral responsibility
Summary
TLDRThis video script delves into the multifaceted realm of public health ethics, categorizing ethical considerations into four domains: individual, group, national, and global perspectives. It explores principles like bioethics, human rights, and the philosophical debates between deontological and utilitarian ethics. The script also examines distributive justice, inequality, and inequity, advocating for the least well-off in society. Finally, it challenges viewers to confront moral responsibility and the concept of moral distance in a global context.
Takeaways
- 📚 Ethics in public health is guided by a framework that categorizes ethical considerations into four buckets: individuals, groups, nation-states, and global civil society.
- 🧩 Bioethics, applicable to individuals, is based on four principles: beneficence, non-maleficence, autonomy, and justice, which are crucial in medical and public health contexts.
- 🌟 Human rights encompass both civil and political rights for individuals and economic, social, and cultural rights for groups, highlighting the importance of rights in health equity.
- 🤔 Deontological ethics, based on absolute rights and wrongs, contrasts with utilitarian ethics, which focuses on maximizing happiness or utility for the greatest number, often used in public health decision-making.
- 🔍 The concept of 'moral responsibility' at a global level prompts reflection on our duty to address historic injustices and their impact on current global health disparities.
- 🌐 'Moral distance' challenges the notion that physical or emotional distance from a situation lessens our moral obligation to act, a concept relevant to global health initiatives.
- 🏛 Distributive justice, a concept by John Rawls, suggests that a just society is one where inequality is arranged to ensure the best possible situation for the least advantaged members of society.
- 🔄 The difference between 'inequality' and 'inequity' is significant, with the former being a neutral term and the latter indicating systematic unfairness that leads to health disparities.
- 🛑 The 'trolley problem' thought experiment illustrates the complexity of ethical decision-making, showing how our moral judgments can change based on the framing of a scenario.
- 🛍️ The example of sacrificing a pair of shoes to save a child's life is used to discuss moral responsibility in the context of global poverty and the need for affluent societies to contribute to global health.
- 🌱 The video emphasizes the importance of understanding and advocating for ethical principles in public health, including the need for nuanced discussions on ethical dilemmas.
Q & A
What are the four buckets of ethical tools mentioned in the framework for public health?
-The four buckets of ethical tools mentioned are: considerations for individuals, groups of people, the nation-state, and global civil society.
What does the term 'bioethics' refer to in the context of public health?
-Bioethics refers to the set of principles that guide ethical decision-making in medical and public health contexts, including beneficence, non-maleficence, autonomy, and justice.
What are the two types of human rights discussed in the script, and how do they differ?
-The two types of human rights are civil and political rights, which apply to individuals, and economic, social, and cultural rights, which apply to groups of people.
What is the difference between deontological ethics and utilitarian ethics?
-Deontological ethics, based on Immanuel Kant's philosophy, asserts that there are absolute rights and wrongs, while utilitarian ethics, developed by Jeremy Bentham and John Stuart Mill, focuses on maximizing the overall good or happiness for the most people.
What is the thought experiment introduced by Philippa Foote to illustrate the complexities of ethical decision-making?
-Philippa Foote's thought experiment involves a trolley problem, where individuals must decide between diverting a trolley to kill one person or doing nothing and allowing it to kill five people, highlighting the nuances of deontological and utilitarian ethics.
What is the concept of 'distributive justice' in the context of nation-states?
-Distributive justice refers to the ethical concept of how resources and benefits should be fairly distributed within a society, taking into account issues of inequality and inequity.
What is the difference between 'inequality' and 'inequity' as discussed in the script?
-Inequality refers to an uneven distribution of resources or outcomes across a society, while inequity specifically denotes a systematic unfairness that leads to such inequalities.
What is the 'veil of ignorance' thought experiment by John Rawls, and what does it aim to illustrate?
-The 'veil of ignorance' is a thought experiment where individuals imagine deciding on the principles of justice without knowing their own position in society, aiming to illustrate how much inequality in society should be tolerated.
What are the two key concepts to consider when discussing public health ethics at a global level?
-The two key concepts are moral responsibility, which involves taking responsibility for historical injustices, and moral distance, which challenges the idea that physical distance should affect our moral obligations.
What is the example given by Peter Singer in his paper 'Famine, Affluence, and Morality' to illustrate the concept of moral distance?
-Peter Singer uses the example of choosing between saving a drowning child at the cost of ruining an expensive pair of shoes versus donating the money equivalent to the shoes to save a child's life in a distant country, to illustrate the concept of moral distance.
Outlines
🔍 Introduction to Public Health Ethics
The video script begins with an introduction to the concept of public health ethics, emphasizing the importance of ethical decision-making in the field. It outlines a framework for addressing ethical issues, categorizing them into four buckets: individuals, groups, nation-states, and global civil society. The speaker promises to delve into each category, starting with a bird's eye view and then explaining specific concepts such as bioethics, human rights, and utilitarian versus deontological ethics. The goal is to provide viewers with a comprehensive understanding of the ethical considerations relevant to public health professionals.
🌟 Bioethics and Human Rights in Public Health
This paragraph delves into the principles of bioethics, which are crucial in medical and public health contexts. It introduces four key principles: beneficence, non-maleficence, autonomy, and justice. Beneficence and non-maleficence focus on the balance of risks and benefits in medical interventions, with the aim to do good and avoid harm. Autonomy emphasizes the importance of informed consent, allowing individuals to voluntarily participate in treatments or research. Justice addresses the fair distribution of healthcare resources and the ethical implications of research outcomes, particularly in the context of trials conducted in developing countries.
👥 Human Rights and Group Ethics in Public Health
The script continues by discussing human rights as they pertain to groups of people, distinguishing between civil and political rights, which are individual freedoms, and economic, social, and cultural rights, which apply to groups and populations. It highlights the importance of these rights in achieving public health goals and the ethical considerations involved in ensuring access to essential services like clean water, housing, education, and healthcare. The paragraph also introduces deontological and utilitarian ethics, setting the stage for a deeper exploration of ethical decision-making within groups.
🤔 Ethical Dilemmas: Deontological vs. Utilitarian Ethics
This section explores the philosophical underpinnings of ethical decision-making, contrasting deontological ethics, which are based on absolute rights and wrongs, with utilitarian ethics, which prioritize the greatest good for the greatest number. The speaker uses the famous trolley problem to illustrate the complexities of these ethical frameworks, showing how the way a problem is presented can influence our moral judgments. The discussion encourages viewers to reflect on the nuances of ethical reasoning and the importance of considering different perspectives.
🏛 Distributive Justice and Inequality in Nation-States
The focus shifts to the ethical responsibilities of nation-states, particularly in the realm of distributive justice. The paragraph clarifies the difference between inequality, which is the uneven distribution of resources, and inequity, which results from systematic unfairness. It challenges the viewer to consider the appropriate level of inequality in society, referencing John Rawls' theory of justice and the concept of the 'veil of ignorance' to explore the idea of a just society where the least well-off are as well-off as possible.
🌐 Global Public Health Ethics: Moral Responsibility and Distance
The final paragraph broadens the ethical discussion to a global scale, introducing the concepts of moral responsibility and moral distance. It prompts reflection on our obligations to address historical injustices and the ethical implications of our actions in a global context. The script references Peter Singer's thought experiment about the moral obligation to help those in need, regardless of geographical distance, and challenges the notion of moral distance as a barrier to fulfilling our ethical duties.
Mindmap
Keywords
💡Ethics
💡Bioethics
💡Beneficence
💡Non-maleficence
💡Autonomy
💡Justice
💡Human Rights
💡Deontological Ethics
💡Utilitarian Ethics
💡Distributive Justice
💡Moral Responsibility
💡Moral Distance
Highlights
Ethics is a framework for decision-making in public health, categorized into four buckets: individuals, groups, nation-states, and global civil society.
Bioethics includes four principles: beneficence, non-maleficence, autonomy, and justice, which are crucial for medical and public health professionals.
Human rights encompass both civil and political rights for individuals, and economic, social, and cultural rights for groups, affecting public health policies.
Deontological ethics, based on Immanuel Kant's philosophy, asserts absolute rights and wrongs, in contrast to utilitarian ethics which focuses on outcomes.
Utilitarian ethics, developed by Jeremy Bentham and John Stuart Mill, emphasizes maximizing happiness or utility for the greatest number of people.
The trolley problem illustrates the complexity of ethical decisions, showing how framing affects moral judgments in deontological vs. utilitarian terms.
Inequality is the uneven distribution of resources, whereas inequity is systematic unfairness leading to such disparities, with different implications for public health.
Distributive justice, as discussed by John Rawls, involves tolerating inequality only to the extent that it benefits the least advantaged in society.
Global public health ethics considers moral responsibility for historical injustices and the concept of moral distance in assisting those in need worldwide.
Peter Singer's thought experiment challenges the notion of moral distance, arguing that our responsibility to help should not be diminished by physical distance.
Ethical considerations in public health require a nuanced understanding of individual rights, group dynamics, national policies, and global responsibilities.
The importance of advocating for good policies based on a deep understanding of distributive justice and equity for public health professionals.
The necessity for public health professionals to balance immediate enforceability of rights with long-term aspirational goals for groups.
The ethical dilemma of autonomy in medical interventions, where patient consent is paramount unless capacity is compromised.
The role of ethical considerations in the aftermath of clinical trials, ensuring participants receive fair benefits from research outcomes.
The philosophical debate between deontological and utilitarian ethics is crucial for making decisions regarding groups in public health.
The significance of understanding both inequality and inequity to effectively address health disparities from a public health perspective.
Transcripts
today we're talking about public health
ethics
ethics is the philosophy around how it
is that we should live what is right in
terms of the decisions and actions that
we take there are a lot of tools that
can be used to think through ethical
issues and ethical problems i put those
tools into four buckets right and this
is a framework that i've developed that
i found quite useful in my career in
public health to think through ethical
problems right so we've got to think
through ethical problems with respect to
individuals groups of people the nation
state and the responsibilities of the
nation state and of course global civil
society okay i hope you find this useful
okay so this is the overall framework
this is the in a nutshell this is the
bird's eye view in this framework you
can see a couple of words and ideas that
you might not be familiar with don't
worry don't panic we're going to go into
each of these things individually one at
a time and i'm going to explain each of
them quite carefully to you just so that
we can just quickly go through the the
overall
idea with respect to individuals we're
going to talk about bioethics i'm going
to explain what is meant by bioethics
and the principles around bioethics
we're going to talk about human rights
now human rights
applies both to the individual
but also to groups of people and they're
applying different ways right so there
are human rights called civil and
political rights and they apply to
individuals and there are human rights
called economic social and cultural
rights and they apply to groups of
people so that's why that the idea of
human rights spans both of these buckets
right in the groups of people buckets
we've got this idea of deontological and
utilitarian ethics right and that's a
really really interesting conversation
about what is right in terms of deciding
what to do with groups of people
extremely important in the context of
public health so we really want to pay
attention and focus on that part of the
conversation then with respect to
countries we want to understand how it
is that nation states and governments in
nation states should make decisions
about the people within the nation
states especially this idea of
distributive justice who has what how
much inequality and inequity is
permissible in the context of a country
right and we're going to distinguish
between the idea of inequality and
inequity so these are ideas and we're
going to tease that out during the talk
and that's super interesting and i know
a lot of you might think well i'm not
part of the government so why does that
matter to me as public health
professionals we need to advocate for
good policies so understanding the
arguments that underpin distributive
justice extremely important for public
health professionals
and then finally we all form part of a
global community global civil society
and there are some ideas and they fall
under two ideas that i've kind of got to
understand and enjoy thinking about one
is moral responsibility and that other
is moral distance so we're going to talk
about all of these things one at a time
thanks for watching until now stick with
me if you're feeling a bit confused
don't worry everything will be clear
very soon okay so hang in there
[Music]
when we think about what is right and
what is wrong with respect to
individuals right we've got this idea of
bioethics and bioethics is something
that applies obviously in the medical
profession more broadly it's not just a
public health issue but of course it
does apply in public health it's also
something that's used in medical
research and by biomedical research a
lot okay in terms of clinical trials et
cetera et cetera so what do we mean when
we talk about bioethics firstly we're
talking about these four principles that
we've all agreed to in the medical world
that we think these are what we think
are important some people add to this
this list isn't a definitive list but
these are the four most commonly ones
that are talked about
right these are terms you may not have
heard before beneficence non-mulphy
non-malfeasance autonomy and justice
beneficence is really the idea that we
should be in the first instance doing
what we think is in the best interest of
the person in front of us right so they
should benefit from whatever it is that
they're participating in and the
non-malfeasance is almost the other side
of the same coin we should not be doing
something or taking an action that we
believe or we know we even expect to not
be in that person's interest to do them
harm now where this is a little bit
tricky is of course with any medical
intervention there are always inherently
a certain risks that we need to take
into account
but when we think about the balance of
the risks and benefits we should draw
the conclusion that we think that this
person will benefit from it and we do
not believe that it's likely that they
will be harmed by our action
notwithstanding the fact that of course
things can go awry and with any medical
or public health intervention there is
always an element of risk
which brings us really to the next at
the next bullet point here which is
autonomy the person needs to be able to
engage with whatever treatment with it
whatever intervention that we're
applying
of their own volition right they need to
have the capacity to make a decision and
they need to have the autonomy to say
yes or no to that particular
intervention and if they don't want to
participate they should be given the
freedom not to now there are exceptions
to that there are times when people
don't have what we call capacity right
there might be severe mental illness or
neurological decline in which a person
isn't able to take a decision on their
own behalf and under those circumstances
their capacity to make a decision is
something that is clinically evaluated
there are very definitive criteria that
get get applied in those circumstances
and making a decision on behalf of
someone isn't taken lightly it's it's a
very serious thing and there are ways of
doing that but that you know but for the
most part for most people we want to
make sure that they have autonomy and
they can decide or decide to or not to
participate in whatever it is that we're
wanting to apply okay stop the video
we're going to go back to talking about
ethics in just one minute i just want to
quickly say a big thank you to the
university of limerick for providing
support to create this video
one of the things that i absolutely love
about the university of limerick's
public health program is that there's an
emphasis on making sure that they are
preparing you for the workplace in other
words they are not just teaching you the
theory of course you're learning all of
the public health theory but they're
teaching you that theory in the context
of making sure that you are following
your graduation really able to make a
real contribution in the public health
space
so if you're thinking of studying public
health take a look at the university of
limerick highly recommend it i think
you'll love it okay let's carry on
talking about public health ethics
and the final thing is justice we want
to make sure that there's no unfairness
that's being applied in other words the
treatment that we're applying isn't
somehow being applied people aren't
being given access to it as a function
of their gender or the ethnicity or the
or some other reason we want to believe
that there's an element of justice we
also want to believe that where people
have for example participated in a trial
that they also benefit from the from the
outcomes of the research of that trial
okay and that's actually something
that's become extremely important with
respect to hiv trials that we've done in
africa where there were people whom
if following the trial the treatment
that they had
spent their risk themselves in a lot of
ways to prove worked was not made
available to them that would have been
considered to be a big injustice in
actual fact with respect to hiv trials
in africa with antiretroviral drugs for
the most part those people were given
antiretrovirals for life even subsequent
to the ending of the trial which i think
was a real boon and demonstrated a real
understanding of this notion of justice
okay so that's bioethics i'm not going
to carry on about that because really
there's so much more we need to talk
about the next thing we're going to talk
about is human rights now there's two
types of human rights have alluded to
that fact
and when we're talking about the
individual we really want to talk about
what's called civil and political human
rights and these are rights that are
applied to individuals these are like
their freedom to vote freedom to
assemble the right to be free from being
tortured
these are things that as an individual i
can request that that right be protected
right i can ask that right be enforced
and i can ask for it to be enforced now
i can today ask that i not be tortured i
can today ask that i have the right to
be able to vote and the reason i'm
making a big deal about the immediacy of
the enforcement of that right is because
it stands in juxtaposition to the other
kind of right we're going to talk about
just now which can't be enforced in any
immediacy right so civil and political
rights these are individual freedoms and
of course we believe that they're
enforceable they should be enforceable
they aren't always enforced we agree as
a global civil society that these are
important and that they should be
enforced and we bestow this right on one
another in other words we agree
collectively to protect
each other's rights to access these
freedoms and of course all of this has
implications for health right if i'm
tortured that's
that's bad for my health if i don't have
the right to participate in civil
society and vote and assemble i don't
have any agency then to have decisions
about how society is managed that might
affect my health i can't influence that
i can't advocate for my own health
environment so these all have
implications for health okay
we're going to now talk about groups of
people and i'm going to start off that
conversation just by continuing to talk
about human rights and the aspect of
human rights that pertains to groups of
people and then we're going to get into
the deontological and utilitarian ethics
which is super duper interesting so
stick with me for that
when we're talking about public health
effects for groups of people again we
want to talk about human rights but this
time we're talking about economic social
and cultural rights right for
individuals it was civil and political
rights those were the freedoms of
individuals these are rights of groups
and of populations
now these are rights like the right to
access clean water the right to housing
the right to education the right to the
highest attainable standard of health
notice that it's not the right to health
but it's the right to the highest
attainable standard of health and that
there's an important difference there
now obviously these things cannot be
enforced remember we said the civil and
political human rights are things that
you could enforce now in the immediate
effect you could have those rights
respected those freedoms could be
attained things like access to fresh
water education housing the right to the
highest attainable standard of health
these are things that that take time to
be put in place they're aspirational
they're normative these are things that
we work toward that we need to invest in
and we and we kind of wanted to get to
right so they can't be enforced in the
immediate effect but there are things
that we believe that people should have
or at least most places around the world
most countries and most governments
believe in these economic social and
cultural rights so they're very
important they're aspirational they're
four groups they have certainly have
public health implications next we're
going to talk about deontological
utilitarian ethics this is maybe the
most important concept that you to get
your head around and i'm going to
just create a new board to talk about
them because there's some interesting
thought experiments that you can use to
to really better understand
the nuances of deontological and
utilitarian ethics
okay deontological and utilitarian
ethics these are two important concepts
and you're really going to enjoy this
it's super interesting right
genetological ethics were developed by
immanuel kant and essentially the idea
there was that there are absolute rights
and wrongs there are things that are
wrong things that are wrong things that
are wrong
simply because we know that inherently
morally ethically these things are wrong
and they're wrong by definition right so
you might say to kill a person is wrong
no matter what the circumstances
it's always wrong to kill a human being
utilitarian ethics developed by jeremy
bentham and and john strutmills
said actually no
what matters is the outcome of your
actions you really want to do the thing
that translates into the most good for
the most people or you know sometimes it
was framed as the most happiness for the
most people but really you're trying to
maximize the utility of humanity or of
group of people and that's what defines
what is right and what is wrong now
interestingly when people are confronted
with these two ideas for the most part
most people
immediately put themselves into one or
other bucket most people sort of have a
knee-jerk reaction and feel as if they
uh resonate with either uh jeremy
bentham or immanuel kant and they they
find themselves in one or other camp
along came somebody by the name of
philippa foote
and she said look it's not quite that
straightforward and she developed a
thought experiment
to try and highlight how difficult it is
to really distinguish right and wrong
with respect to these two different
frameworks and the thought experiment
went along the lines along i want you to
do this with me use your imagination and
do this thought experiment and you'll
see exactly what i mean
right so she said look imagine a tram or
trolley and in this case you'll see i've
drawn a little train it's not a very
good drawing but you know it's the best
i could do and it's going along a track
and
it's heading
on the track it's natural courses to go
down this way and some evil villain has
tied
five people to the track
and if it goes down that track the train
or the tram or the trolley is going to
kill all five people for sure they they
will not survive
interestingly you're standing a little
ways off you're in the little hut that
the
train people stand in and you've got a
lever that you can pull and if you pull
that lever the train will be diverted
onto an alternative track and on this
alternative track of course uh what's
going to happen is there's just one
person tied to the alternative track and
that person will get hit by the train
and they'll die but you'll have saved
the five people and so the first
question that philippa foot asked is
would you pull the lever
and save the five people
knowing of course that there'd be one
person that still did die when asked and
you might find this yourself as you
listen to me
most people respond they would pull the
lever and make that decision
now interestingly that is a utilitarian
decision right it's maximizing the
utility of this particular set of
circumstances it is killing a person so
it's doing something that would would
consider to be deontologically wrong
but it is we're maximizing utility but
then she said let's take this experiment
a step further
and let's imagine that you now don't
have a lever but instead you've got a
footbridge
and i would try and draw the footbridge
for you but i really you know the train
is the best i could do in terms of
drawing i wouldn't get this right but
you've got a foot bridge that's going
over the track
you do not have a lever to pull but
you've got a footbridge and on that
footbridge
there's a
and you could push the off the
footbridge onto the track and that
footbridge that tram would would you
would push him he would fall off
and he'd land on the track and die
and he'd be hit by the train but he
would stop the train
and of course the the five people would
be saved
so the question is would you
climb onto that footbridge and kill the
push him off the edge and
when the problem is framed like that
most people overwhelmingly
the vast majority of people said they
wouldn't do that they couldn't do that
now strictly speaking those two
scenarios are from an ethics and moral
point of view the exact same thing right
you're sacrificing one person to save
five
but the problem is it's framed in a
different way and our brain processes
that information in different ways when
you're pulling the lever the part of
your brain
that
considers the ethical dilemma simply
makes a calculation it's a sort of
prefrontal cortex it just sort of says
five is more than one that's the better
option let's save the five when you're
thinking and imagining yourself on a
footbridge
actually getting up close and personal
and killing a person suddenly your
emotional centers are evoked and you
make that ethical decision in a
different part of your brain and under
both circumstances you are quite sure
that you're making the right decision
and most people will swap and then of
course the trolley experiments can get
changed in multiple ways
you could say well on the footbridge the
person that you're going to push off the
footbridge and they're going to die
to save the five isn't a but
rather it's the evil villain that tied
the five people there in the first place
and then suddenly people are like oh
hang on hold the phone we don't mind
killing him or her
let's you know that's fine that's
justifiable so there are multiple
versions and iterations there's versions
of the trolley experiment where the
track loops back on itself and it gets
more and more complicated but the point
is every iteration of this thought
experiment demonstrates to us
that what we think is right and wrong is
for the most part a function of how it
is that the problem is framed and we
need to think about that we need to keep
that in mind very carefully when we get
into debates with people about moral and
ethical public health problems and not
fall into the trap of simply believing a
particular paradigm because it's framed
in a way or is just sort of too sort of
too much on the side of a pure
calculation it doesn't take the humanity
of the situation into account we have to
be more nuanced than that now
what does this mean
have i taken away two two tools from you
or have i given you two tools that you
can use i don't know uh all i know is we
can't go into these conversations
without having that introspective nuance
that ability to kind of really reflect
on our own position critically and make
sure that when we go into an argument
about ethics that we're aware that
there's often another side to the story
which may be quite compelling depending
on how it is that that story is being
read
okay so we've talked about the
individual level we've talked about
groups of people now we're going to talk
about the nation-state countries how it
is that countries and governments should
apply the ideas of ethics public health
ethics and decisions they make
specifically with respect to this idea
of distributive justice and inequity and
inequality
okay before we start talking about
distributive justice
and there's a fantastic paper i'm going
to talk about by john rolls i want to
talk about the idea of inequality and
inequity these two terms get banded
about they sometimes get used
interchangeably they mean different
things and it's really important that we
understand them if we're going to really
talk about the concept of justice and
distributive justice okay so let's just
talk firstly about inequality
inequality is when there's an uneven
distribution of something across social
delineations right it could be any
delineation it could be gender it could
be short people tall people uh irish
people south africans any delineation
any way of dividing society up when
there's an uneven distribution of
something across those delineations we
call it inequality right now not all
inequality is bad so men
are taller than women that's not
necessarily a bad thing it's just a
thing just it happens it's just a fact
of the matter uh dutch people are taller
than british people
again it's not a good thing it's not a
bad thing it's just a thing and we just
we just live with it there are some
inequalities however
that exist because of pre-existing
unfairness
systematic unfairness in society and we
call that unfairness inequity so
inequity is a systematic unfairness that
leads to
inequality good example is apartheid
south africa had rules and legislation
in place
that meant that black south africans had
economic disadvantages and health
disadvantages and whole and educational
disadvantages i mean a whole string of
freedoms denied to them there was a
systematic unfairness in society and
that led to inequalities so there was
inequity that led to inequalities now
importantly when we're talking about
health
there is a tendency to use this term
health inequities which are
health inequalities that are a function
of an unfairness and and that's a real
thing there are
unfairnesses that lead to you know there
could be economic unfairnesses there
could be all sorts of unfairnesses in
south africa that have health
consequences
and there's this term
there's this catch-all term called
health inequity that people try to use
to capture those things the trap that
people fall into is believing that those
are and only those are the inequalities
that we should be addressing and that's
not true
while it is the case that health
inequities these inequalities that are a
function of some sort of unfairness have
to be addressed at a social level we
need to kind of make sure that we live
in a fair society
that doesn't translate into these sorts
of inequalities it's also true that
health inequalities
that have nothing to do with unfairness
if it is possible for us to address them
we should
okay let me give you an example as a
caucasian i'm more likely to develop
skin cancer than somebody that's darkly
pigmented
right that's not an unfairness i'm not
being cheated by the world
it's just a difference a biological
difference between myself and my
counterparts that are darker than me
should we try and address that as a
public health community of course we
should be telling people like me to wear
sunscreen to stay out of the sun
and you know to avoid some of the the
risks associated with skin cancer all
right so it's not just an inequalities
that are a function of unfairness that
need to be addressed we need to address
any health inequality where we are able
to and of course it's true that where
there's inequity where there's
unfairness absolutely we have to address
that that's you know that almost goes
without saying but
it's also true that it has to be said
because we see examples of it all over
the world where unfairnesses are not
being addressed okay so that's
that's inequality and inequity and
that's important to understand that
because next we're going to talk about
this idea of distributive justice and
how much inequality in a society should
we tolerate
okay when we talk about distributive
justice there was a paper written by
somebody by the name of jonathan rawls
and
he wrote this paper called theory of
justice and it was a very influential
paper and it talked about the idea of
inequality in society and how much
inequality we should tolerate
and these are very badly drawn scales
down here and i'm going to get back to
those in a second but really john rolls
came up with a thought experiment and
again i want you to do this thought
experiment in your mind as as i talk it
through imagine yourself in the
situation john said okay put yourself
behind what he calls the veil of
ignorance he calls it the original
position
it's you remove yourself from your life
imagine that you're behind this veil of
ignorance and it's called available
ignorance because on that you don't know
what your life was like on the other
side you've been removed from life
and the world
and you don't remember whether you were
black or white whether you were
tall short male female a south african
or irish you don't know anything about
the life that you're going to go back to
and you're going to go back to that life
now
given that you're going to go back to
that life
and you don't know who you're going to
be
what level of inequality
would you opt for
while you're here on on this side of the
veil of ignorance what would you
consider to be appropriate
knowing that in that the world you're
going back to could be
dramatically unfair with huge
inequalities and you could be at the
bottom end in fact in the world that
we're living at the moment it would be
overwhelmingly likely that you would be
somewhere in the sort of bottom end you
know the sharp end of inequality you
know and we do live in a world where a
very very few people you know kind of
really control the vast majority of the
wealth in the world so the question is
from behind the veil of ignorance where
would you how much inequality would you
want in society when you came back it's
an interesting question and he came up
with a way of thinking about it a way to
kind of answer that question because
it's you know on the one hand you might
say oh no i want to come back to a
completely you get an egalitarian world
where
there's no inequality whatsoever and he
argued against that as well by the way
and this is where our three little
scales come in and here's here's what
john rolls kind of suggested he said
each of these scales represents sort of
a certain level of inequality in society
and he was saying look you could have a
completely egalitarian society with it
everybody has exactly the same amount of
absolutely everything and you don't
really have any
any people that are tremendously poor
the other extreme you could have a
situation where you have a lot of
inequality but it might translate into a
tremendously wealthy society but they
would in that society be some people who
are tremendously poor
now john rolls kind of argued that what
you you don't really want that either
and although to a large extent that is
the world that we're currently living in
he argued that what you really want is a
world where there's
some inequality
but only inequality in so much as it
translates into the least well of
being as well off as possible in other
words in this scenario because of a
little bit of inequality and sometimes a
little bit of inequality could spur
competition and incentives et cetera et
cetera i mean there are reasons why some
inequality in the world actually has
economic benefit but he said you only
want to tolerate as much inequality as
translates into the least well-off so
the people at sort of this side of
the equation being as well off as
possible in other words
where these people over here
are better off than these people over
here
so if we were to draw a line a dotted
line of their level of well-being it's
assumed that they're over here where the
least well-off in society are the best
that they could possibly be
that's the level of inequality that we
should aspire towards more inequality
could lead to the least well of being
less well-off than
this completely egalitarian situation
even if society under those
circumstances was a richer society so he
was saying let's not go for that let's
go for a sort of middle ground with the
least well of uh in other words he said
the benchmark for what we should
tolerate and what we should aspire
toward is how well off or how are
the least well-off in society that's our
barometer those are the people that we
need to be concerned about
not the overall economy not the wealth
of the nation not the gdp per capita not
the economic growth rate or none of that
how well off are the least well-off in
your society that's the measure
of whether or not that's the level of
inequality that you should tolerate and
that's in terms of distributive justice
what it is that you should be aspiring
towards okay i hope that was useful now
we're going to go on to thinking about
public health ethics from a global
perspective
okay so we've talked about the
individual we've talked about groups of
people we've talked about countries and
so obviously the next thing to talk
about is at a global level let's talk
about moral responsibility and moral
distance
when we talk about public health ethics
at a global level there's two ideas that
we need to think about one is moral
responsibility and the other is moral
distance now i don't have the answers to
some of the questions that these ideas
pose but i do think that we need to be
cognizant of them moral responsibility
is the extent to which we need to take
responsibility for historic injustices
that we have benefited from
okay and there's lots of examples of
that and the question that needs to be
grappled with would be how far back do
you go and to what extent do you
take moral responsibility for historic
injustices and what does that mean how
should you respond to that so there's
this historic injustice you're going
back in time you take moral
responsibility for things that happened
in the past the other is physical
distance and this is this idea of moral
distance
now peter singer wrote a very
influential paper called famine
affluence and morality
and in it he posed a thought experiment
and he said look if you're walking down
the road
and you pass a child drowning in the mud
and you're able to save that child
you're just well able to save that child
the problem is that if you were to save
that child the only way you could do it
would be to get your feet stuck in into
the mud and there you've just bought a
very expensive pair of shoes
and those shoes would be ruined
i think most of us agree that you
shouldn't care too much about the shoes
but you should sacrifice the shoes and
help the child out of the mud and save
the child's life and that's my little
diagram here by the way that's a shoe
stuck in the mud i know it doesn't look
like it i'm not a great artist as you've
probably figured out by now
now so we all agree save the child
sacrifice the shoes none of us have a
problem with that
but something that peter singer pointed
out is that in actual fact we are faced
with that exact dilemma all of the time
right there are reputable charities out
there
to which we could give
the equivalent of
an expensive pair of shoes in full
confidence that that might translate
into a child's life being saved or
perhaps a child being educated or
treatment for a child uh to be you know
to be treated for some sort of illness
but
these these are children in africa or in
southeast asia and some part of the
world where they're
so far away from us that it's easy for
us to detach ourselves emotionally from
their plight
and we absolve ourselves of this sense
of moral responsibility so peter singer
was saying basically the distance
shouldn't matter
distance isn't an issue there's no such
thing as moral distance essentially the
responsibility to save a child's life if
you're able to
should apply
regardless of where it is in the world
that you are so interesting idea
interesting challenge to us all i hope
you found this video useful please
subscribe to this channel if you haven't
already hit the bell notification if you
want to get notified of future videos
like this you can join the channel as a
member that's a slightly different thing
and the members of course get access to
different videos
that's mostly about jobs and careers in
the global and public health space
i've also got a website called
learnmore365.com
and i've got lots more teaching material
uh there in a lot more detail okay
thanks for watching hope you enjoyed
this take
[Music]
5.0 / 5 (0 votes)