A blog from the Centre for Research Ethics & Bioethics (CRB)

Tag: virtue ethics

Does public health need virtue ethics?

So-called virtue ethics may seem too inward-looking to be of any practical use in a complex world. It focuses on good character traits of a morally virtuous person, such as courage, sincerity, compassion, humility and responsibility. It emphasizes how we should be rather than how we should act. How can we find effective guidance in such “heroic” ethics when we seek the morally correct action in ethically difficult situations, or the correct regulation of various parts of the public sector? How can such ancient ethics provide binding reasons for what is morally correct? Humbly referring to one’s superior character traits is hardly the form of a binding argument, is it?

It is tempting to make fun of the apparently ineffective virtue ethics. But it has, in my view, two traits of greatest importance. The first is that it trusts the human being: in actual situations we can see what must be done, and what must be carefully considered. The second is that virtue ethics thus also supports our freedom. A virtuous person does not need to cling to standards of good behavior to avoid bad behavior, but will spontaneously behave well: with responsibility, humility, compassion, etc. So a counter-question could be: What good will it be for someone to gain a whole world of moral correctness, yet forfeit themselves and their own freedom? – This was a personal introduction to today’s post.

In an article in Public Health Ethics, Jessica Nihlén Fahlquist discusses public health as a domain of work where moral virtues may need to be developed and supported in the professionals. Unlike medical care, public health focuses on good and equal health in entire risk groups and populations. Due to this more universal perspective of collective health, there can be a risk that the interests, rights and values ​​of individuals are sometimes overlooked. The work therefore needs to balance the general public health objectives against the values ​​of individuals. This may require a well-developed sensitivity, which can be understood in terms of virtue ethics.

Furthermore, public health is often characterized by a greater distance between professionals and the public than in medical care, where the one-on-one meeting with the patient supports a caring attitude in the clinician towards the individual. Imagination and empathy may therefore be needed in public health to assess the needs of individuals and the effects of the work on individuals. Finally, there is power asymmetry between public health professionals and the people affected by the public health work. This requires responsibility on the part of those who use the resources and knowledge that public health authorities possess. This can also be understood in terms of virtue ethics.

Jessica Nihlén Fahlquist emphasizes three virtues that she argues are needed in public health: responsibility, compassion and humility. She concretises the virtues through three ideals to personally strive for in public health. The ideals are described in short italicized paragraphs, which provide three understandable profiles of how a responsible, compassionate and humble person should be in their work with public health – three clear role models.

The ethical problems are made concrete through two examples, breastfeeding and vaccination, which illustrate challenges and opportunities for virtue ethics in public health work. Read the article here: Public Health and the Virtues of Responsibility, Compassion and Humility.

Jessica Nihlén Fahlquist does not rule out the importance of other moral philosophical perspectives in public health. But the three virtue ethical ideals (and probably also other similar ideals) should complement the prevailing perspectives, she argues. Everything has its place, but finding the right place may require good character traits!

If you would also like to read a more recent and shorter discussion by Jessica Nihlén Fahlquist on these important issues, you will find a reference below.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

Jessica Nihlén Fahlquist, Public Health and the Virtues of Responsibility, Compassion and Humility, Public Health Ethics, Volume 12, Issue 3, November 2019, Pages 213–224, https://doi.org/10.1093/phe/phz007

Jessica Nihlén Fahlquist, Individual Virtues and Structures of Virtue in Public Health, Public Health Ethics, Volume 15, Issue 1, April 2022, Pages 11–15, https://doi.org/10.1093/phe/phac004

This post in Swedish

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Our individual responsibility for antibiotic resistance

Antibiotic resistance is a global threat to public health, as the chances of treating infections decrease when antibiotics lose their effect on bacterial growth. But who is responsible for antibiotic resistance and what is the responsibility?

We may believe that the problem is too big and complex for us as individuals. Antibiotic resistance is a problem for governments and international organizations, we think. Nevertheless, it is not least our individual use of antibiotics that drives the development. For example, we may take antibiotics when it is not really necessary, or perhaps we do not follow the doctor’s prescription but discontinue the antibiotic treatment prematurely and throw leftover pills in the dustbin. Then we go on a journey and spread bacteria that are resistant to the antibiotic that we did not use properly. Or we ignore getting vaccinated because we think that there are antibiotics if we get sick. Well, maybe not for long!

If we have an individual moral responsibility to act with awareness of environmental problems, then it is not unreasonable to think that we also have a responsibility to act with awareness of the antibiotic problem. Mirko Ancillotti (who recently defended his dissertation at CRB) examines this possibility in an article in Bioethics. Do we have an individual moral responsibility for antibiotic resistance and how should the responsibility be understood?

Mirko Ancillotti immediately points out that not all people have the same opportunities to improve their antibiotic behaviour. Apart from the fact that many people lack information about antibiotic resistance, not everyone finds it as easy to change their antibiotic use. Some have less access than others to correctly prescribed treatments, for example, if they live far from a hospital but can easily buy antibiotics without a prescription. In addition, not everyone has the same financial means to stay at home if they are ill.

Another thing that makes it difficult to talk about individual responsibility for antibiotic resistance, is that you can hardly determine how much the pills you threw in the dustbin actually contributed to the problem. We know that people die due to antibiotic resistant bacteria, but it is difficult to determine the consequences of your particular antibiotic behaviour.

For these reasons, Mirko Ancillotti proposes a virtue ethical concept of responsibility. He suggests that we as individuals cultivate personal qualities and habits, which support responsible antibiotic use as a virtue. If I understand him, this means cultivating certain norms about antibiotics use, which we try to meet, such as following the doctor’s prescription, not using antibiotics unless necessary, not persuading the doctor to prescribe antibiotics, and making sure that we are vaccinated. However, since the conditions for acting with this normative sensitivity vary with human circumstances, there is in many cases a need to improve the conditions and institutional support for responsible antibiotic use.

A comparison: We have learned that we should preferably not travel by air, that it is irresponsible and perhaps even shameful to fly if it is not necessary. To be able to meet this new norm, new societal conditions are needed in the form of better international train connections and simpler ticketing systems. In the same way, new normative sensitivities regarding antibiotics can be developed, simultaneously with improving the opportunities for meeting the norms, Mirko Ancillotti suggests.

If you want to read more about Mirko Ancillotti’s virtue ethical concept of an individual responsibility for antibiotic resistance, read the article in Bioethics: Individual moral responsibility for antibiotic resistance.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

Ancillotti, M., Nihlén Fahlquist, J., & Eriksson, S. (2021). Individual moral responsibility for antibiotic resistance. Bioethics, 1– 7. https://doi.org/10.1111/bioe.12958

This post in Swedish

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