Fairness and Freedom in Public Health Policy

Part of the Medical Humanities events

Monday 23 October and Tuesday 24 October 2023

Please follow the link to register.

Restrictive public health policies limit individual freedoms in the pursuit of collective health goods. According to a widely endorsed principle of “least restrictive alternative”, only the lowest level of restrictiveness necessary to achieve a public health goal is justified. However, the same restrictions affect different people differently, and the same good benefits different people differently. Arguably, what matters is not only how restrictive a policy is, but also whose freedom is restricted and why.

Across times and places, restrictive policies have often pursued collective goods at the cost of unfairly distributing restrictions. While the problem is not new, it has been brought to the fore during the recent pandemic and will likely emerge as a key challenge in future public health policies. The conference will analyse from a multidisciplinary, Humanities-focused perspective the issue of fairness in the distribution of freedom restrictions in public health policy, bringing together experts from Philosophy, History, Public Policy, Politics, Anthropology, and the Social Sciences.

Convenor:

Alberto Giubilini

Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy

Wellcome Centre for Ethics and Humanities

University of Oxford

With the support of:

Oxford Medical Humanities, University of Oxford

Wellcome Centre for Ethics and Humanities, University of Oxford

John Fell Fund

Society for Applied Philosophy

Speakers:

Sorin Baiasu (Keele University), Philosophy

Kevin Bardosh (University of Washington), Medical Anthropology

Seung-Hoon Chae (University of Oxford), Politics

Hohee Cho (University of Oxford), History

Erica Charters (University of Oxford), History

Samuel Director (University of Florida Atlantic), Philosophy

Maja Graso (University of Groningen), Social Sciences

Mark Harrison (University of Oxford), History

Peter Horby (University of Oxford), Global Health

Michael Parker (University of Oxford), Bioethics

Anna Petherik (University of Oxford), Policy

Sadie Regmi (University of Oxford), Bioethics

Lucie White (Utrecht University), Philosophy

Bridget Williams (University of Oxford), Philosophy

PROGRAM

23 October 2023

9.15-9.45 Coffee upon arrival

9.45-10.00 Introduction: Alberto Giubilini (Oxford)

Morning session

Freedom Restrictions across Time and Places

Chair: David Robertson (Oxford)

10.00-10.25 Anna Petherick (Oxford) The Oxford COVID-19 Government Response Tracker

10.25-10.50  Seung-Hoon Chae (Oxford) Fines and Social Distancing: a Tale of Two Parties

10.50-11.15 Hohee Cho (Oxford) The Central Leper Hospital: How Colonial Pacific Islands Contained Hansen’s Disease

11.15-11.45 Coffee break

11.45-12.15 Discussion on the morning topics

12.15-12.30 Mark Harrison Reflections on the morning themes

12.30-14.00 Lunch

Afternoon session

Disagreement, Uncertainty, and Potential Harms of Restrictive Health Policies

Chair: Angeliki Myrillas-Brazeau (Oxford)

14.00-14.25 Kevin Bardosh (Washington), An Index of Societal Harms from COVID-19 Non-Pharmaceutical Interventions: Political and Philosophical Reflections

14.25-14.50 Lucie White (Utrecht), Policymaking under Uncertainty in Public Health and Beyond

14.50 -15.15 Maja Graso (Groningen), Invisible Threats & Burdens of Proof: Social Division during Uncertainty

15.15-15.45 Coffee break

15.45-16.15 General discussion on the afternoon themes 

16.15-16.30 Peter Horby (Oxford), The Pandemic Sciences Institute and the Humanities

16.30-16.45 Erica Charters (Oxford), Reflections on the day

24 October 2023

9.15-9.30 Coffee upon arrival

Morning session

Fairness, Freedom, and Public Health: Philosophical and Bioethical Perspectives

Chair: Tess Johnson (Oxford)

9.30-9.55 Samuel Director (Florida Atlantic), Civil Liberties in a Lockdown: the Case of COVID-19

9.55-10.20 Sadie Regmi (Oxford), Viruses and Freedom of Intimate Association

10.20-10.50 Discussion

10.50-11.10 Coffee break

11.10-11.35 Sorin Baiasu (Keele), Justice, Desert, and Public Health

11.35-12.00 Bridget Williams (Oxford), Fairness and Selective Vaccine Mandates

12.00-12.30 Discussion

12.30-12.45 Michael Parker (Oxford), Reflections on the day

12.45-13.00 Alberto Giubilini (Oxford), Concluding remarks

ABSTRACTS

Sorin Baiasu (Keele): Justice, Desert, and Public Health

One principle of distributive justice considered in public health is desert-based. According to this principle, individuals who take a responsible attitude towards their health may be given priority for certain public health interventions regardless of their background circumstances. This is not a principle widely adopted in public health and for some good epistemological reasons. Nevertheless, desert-sensitive criteria of distribution are worth considering in the context of debates over the fairness of restrictive public health policies. Thus, recent defences of desert-sensitive theories of distribution claim to be able to respond to libertarian worries concerning the limitations of individual freedoms in the pursuit of fair distribution of goods in society. In this paper, I examine the extent to which desert-sensitive theories can provide some answers to conflicts between individual freedoms and collective health goods.

Kevin Bardosh (University of Washington): An Index of Societal Harms from COVID-19 Non-Pharmaceutical Interventions: Political and Philosophical Reflections

Pandemic restrictions have caused significant harms to individuals and groups. The distribution of these harms across individuals and groups has been uneven. Some groups have shouldered larger burdens in terms of financial losses, education gaps, physical and mental health, and so on. In this talk I will explore some of these harms and their distribution and I will reflect on some ethical implications.  

Seung-Hoon Chae (Oxford):  Fines and Social Distancing: a Tale of Two Parties

How strong is partisanship’s association with social distancing behaviour? Previous studies have found that identifying with the political right diminished social distancing levels in a number of different political contexts, including the United States, the United Kingdom, Brazil and Italy. By comparison, South Korea is an improbable case for partisanship to have such influence. For one, right-wing political elites provided no cues to resist social distancing rules. Moreover, due to robust norms, even supporters of the right tend to express vehement objection against rule-breaking behaviour. Notwithstanding such a tough environment, however, partisanship had a prominent effect on social distancing. Interestingly, this non-compliance found among supporters of the political right could be mitigated through imposing greater financial penalties. The study consists of a survey experiment on 2,192 participants in the Republic of Korea from 30th September to 5th October 2022. The results discussed in this paper are exploratory in nature. The pre-registered study’s original objective was to investigate more generally whether penalties can increase compliance with social distancing rules. Although the study was unable to find evidence for its primary hypotheses due to ceiling effects, the experiment uncovered an unlikely relationship between partisanship, punishment, and social distancing.

Hohee Cho (Oxford): The Central Leper Hospital: How Colonial Pacific Islands Contained Hansen’s Disease

This paper examines the process of restricting the freedom of Hansen’s disease patients to free the Pacific Islands of the fear of leprosy through the case of the Central Leper Hospital. Established in 1927, the Central Leper Hospital was run by the government of Fiji, staffed by French Catholic nuns, and jointly funded by participating colonial administrations of Fiji, the Solomon Islands, the Gilbert and Ellice Islands, Tonga, Western Samoa, the Cook Islands and American Samoa. Why did the Pacific Islands establish such an intercolonial institution? How did the governments gain patients’ consent? And what was life like in the isolated island hospital? In answering these questions, this paper will assess the colonial governments’ approach to public health in the Pacific Islands during the 1920s.  

Samuel Director (Florida Atlantic): Civil Liberties in a Lockdown: The Case of COVID-19

In response to the spread of COVID-19, governments across the world, with very few exceptions, have enacted sweeping restrictive lockdown policies that impede citizens’ freedom to move, work, and assemble. I critically respond to the central arguments for restrictive lockdown legislation. I build my critique on the following assumption: public policy that enjoys virtually unanimous support worldwide should be justified by uncontroversial moral principles. I argue that the virtually unanimous support in favor of restrictive lockdowns is not adequately justified by the arguments given in favor of them. Importantly, this is not to say that states ought not impose restrictive lockdown measures, but rather that the extent of the acceptance of these measures is not proportionate to the strength of the arguments for lockdowns.

Maja Graso (Groningen): Invisible Threats & Burdens of Proof: Social Division during Uncertainty

Should decision-makers strive to inspire uniform, collective action against “invisible threats”? The COVID-19 pandemic, as an example of one such threat, has created divisions due to the lack of a clearly identifiable source of the problem, a range of valid ways in quantifying direct and indirect harm associated with it, and challenges in determining whether the responses were proportional to the threat. This talk will discuss how efforts to foster collective action through simplification of messaging can be a double-edged sword. Without simplifying such issues, it is nearly impossible to achieve collective action and majority support for stringent measures; however, through simplification, decision-makers may inadvertently limit information and create misinformation of their own. The COVID-19 pandemic presents an instance where such simplification led to an overestimation of risks, ostracising those seen as uncompliant, and overall social division along multiple dimensions. When threats are not inherently obvious to the majority, attempts to make them so can foster compliance but also create division and resistance. The talk aims to stimulate a thoughtful dialogue about the ethics and decision-making processes involved in simplifying complex information, and the delicate balance between inspiring collective action and avoiding misinformation and social fragmentation during uncertain times.

Anna Petherick (Oxford): The Oxford COVID-19 Government Response Tracker and Selective Mandatory Vaccination

I will give an overview of the Government Response Tracker developed with colleagues at Oxford, to measure the level of restrictiveness of policies in different countries during the COVID-19 pandemic. I will also present the results of recent work with colleagues at the Blavatnik School of Government on the effectiveness of selective restrictive vaccination policies.

Sadie Regmi (Oxford): Viruses and Freedom of Association

In this paper, I argue the following: (1) Individuals have a right to freedom of intimate association. (2) Lockdowns restrict freedom of intimate association. (3) It is pro tanto wrong of governments to impose measures that restrict freedom of intimate association (4) It is a further wrong to differentially restrict this freedom. (5) Lockdowns are pro tanto wrong for reasons in 1-4. Nevertheless, freedom of intimate association can be justifiably restricted given certain conditions are met so lockdowns may be all things considered justified. However, policies that restrict freedom of intimate association involve difficult trade-offs that we should be concerned about and seek to mitigate.

Lucie White (Utrecht): Policymaking under Uncertainty in Public Health and Beyond

The precautionary principle is often put forward as potentially useful guide to avoiding catastrophe under conditions of uncertainty. But finding an adequate formulation of the principle runs into a problem when needed precautionary measures also have potentially catastrophic consequences – the imperative to avoid catastrophe appears to recommend both for and against the measures. Drawing from the early pandemic, we suggest a way around this “problem of paralysis”: We should recognize and incorporate an asymmetry between our options, based on whether there is a possibility of intervening later to prevent the worst outcome.

Bridget Williams (Oxford): Issues of Fairness in Selective Vaccine Mandates

During the COVID-19 pandemic some countries introduced selective vaccine mandates for specific population groups. I argue that mandating vaccination for those at high risk of severe disease is justified on the basis of the harm principle, as there is evidence that this would remove the grave public health threat of COVID-19. The risk–benefit profile of vaccination is also more clearly in the interests of those at highest risk, so mandatory vaccination entails a less severe cost to them. A selective mandate would create fairness in the distribution of risks. The level of coercion imposed by a mandate would need to be proportionate, and it is likely that multiple approaches will be needed to increase vaccine uptake.

For further information please contact Alberto Giubilini, alberto.giubilini@philosophy.ox.ac.uk.

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