Is the Cure Worse than the Disease? The Ethics of Imposing Risk in Public Health

Diego S Silva; Maxwell J Smith

doi:10.1007/s41649-022-00218-1

Is the Cure Worse than the Disease? The Ethics of Imposing Risk in Public Health

Asian Bioeth Rev. 2022 Sep 10;15(1):19-35. doi: 10.1007/s41649-022-00218-1. eCollection 2023 Jan.

Authors

Diego S Silva¹, Maxwell J Smith²

Affiliations

¹ Sydney Health Ethics, School of Public Health, University of Sydney, Sydney New South Wales, Australia.
² School of Health Studies, Western University, London Ontario, Canada.

Abstract

Efforts to improve public health, both in the context of infectious diseases and non-communicable diseases, will often consist of measures that confer risk on some persons to bring about benefits to those same people or others. Still, it is unclear what exactly justifies implementing such measures that impose risk on some people and not others in the context of public health. Herein, we build on existing autonomy-based accounts of ethical risk imposition by arguing that considerations of imposing risk in public health should be centered on a relational autonomy and relational justice approach. Doing so better captures what makes some risk permissible and others not by exploring the importance of power and context in such deliberations. We conclude the paper by applying a relational account of risk imposition in the cases of (a) COVID-19 measures and (b) the regulation of sugar-sweetened beverages to illustrate its explanatory power.

Keywords: Complexity; Public health; Relational autonomy; Relational justice; Risk.