Demographic And Health Analysis: Country Report & Analysis Overview

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Moral and Ethical Considerations

Maria Merritt, PhD Johns Hopkins University

!  Terminology: “Moral” and “Ethical”

!  Moral reasons for engaging in international health programs and research

!  Ethical conduct of work in international health

Overview

!  No uniform correct way to use these terms

!  A helpful way to use them in this class !  Moral reasoning involves critical reflection on the right way for human beings to

treat each other

!  Ethical conduct involves doing right by people in specific contexts of action •  Especially in professional contexts

Terminology: “Moral” and “Ethical”

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Moral Reasons for Engaging in International Health

Section A

!  Why should it be thought that “the peoples of wealthy nations, or their governments on their behalf, should take measures to improve health in the developing world”? (Wolff, p. 78)

What Is the Basis of the Global Health Duty?

!  Justice: moral obligations across borders !  Libertarianism !  Nationalism !  Cosmopolitanism

!  Justice: human rights perspective

!  Humanitarian duty

Outline

National Boundaries and Duties of Justice

Duties to assist the disadvantaged in your

own country

Duties to assist the disadvantaged in other

countries

Moral rationale: Who owes what to whom?

Libertarianism X All people primarily owe each other only non-interference Nationalism Moderate X

Compatriots bound by same government have distinct positive

moral claims on each other

Cosmopolitanism Extensive People universally have positive

moral claims on each other

Justice: Cosmopolitan Perspective

!  “Southern states are now epicenter of HIV/AIDS in the US” (Teresa Wiltz, Washington Post, September 22, 2014)

!  “None of the nine Deep South states with the highest rates of new HIV/AIDS diagnoses— Alabama, Georgia, Florida, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and Texas—have opted to expand Medicaid under the Affordable Care Act. Those states also have the highest fatality rates from HIV in the country …”

!  A physician recently treated “… a young man in Montgomery, Ala., who was blinded by cryptococcal meningitis, a disease typically found among HIV-positive people living in sub-Saharan Africa.” Said the treating physician ... !  “That’s a tragedy that shouldn’t happen in our country.”

How Are We Doing in the US?

Cosmopolitanism as Possible Basis for Global Health Duty

Duties to assist the disadvantaged in your

own country

Duties to assist the disadvantaged in other

countries

Moral rationale: Who owes what to whom?

Libertarianism X All people primarily owe each other only non-interference Nationalism Moderate X

Compatriots bound by same government have distinct positive

moral claims on each other

Cosmopolitanism Extensive People universally have positive

moral claims on each other

Justice: Human Rights Perspective

!  Human rights can be seen as moral claims that are “embodied in the practices of international law” (Wolff, p. 86) !  Conventions, declarations, international courts

!  “… it is possible to accept the doctrine of human rights from a variety of moral or political standpoints, of which the cosmopolitan perspective is merely one” (Wolff, p. 98, note 26)

Human Rights

!  “Different people will find their own [moral] justifications”

!  No moral perspective has a “privileged place as providing the core foundation” for the political doctrine of recognizing human rights

!  Human rights have “moral foundations, but no particular moral foundation”

Broad Appeal of Human Rights

!  Duties based on human rights typically require the international community to remain silent and not criticize government actors

True or False?

Human Rights in Action

Right holders All human beings

Primary duty bearers Government of each country

Role of compatriots within each country

“... criticize ... regime for failing to meet the human rights of its citizens” (Wolff, p. 88)

Role of international community

“... criticize ... regime for failing to meet the human rights of its citizens” (Wolff, p. 88)

“... take steps to encourage and assist national governments in carrying out their duties ...” (Wolff, p. 86)

“... perhaps pick up the duty in extreme cases of failure ...” (Wolff, p. 86)

Humanitarian Duty

Humanitarian Assistance (Wolff, pp. 93–96)

Who ought to act? Whoever “is best placed” to act in fulfillment of unmet health needs (Wolff, p. 93)

What kinds of action are required?

Provision of money, health care, supplies, facilities, etc.

To whom is humanitarian assistance owed?

"  No one in particular "  You might act wrongly if you never offered humanitarian assistance "  But no one can say “it is owed to me!”

How is humanitarian assistance related to the “international social structure?

Tends to leave in place existing asymmetries of wealth, power, and status

!  Each line of reasoning requires defense through moral argumentation !  Maybe “different types of programs, in different countries, have different [moral]

justifications” (Wolff, p. 79) !  Moral foundations make a difference to determining “when enough has been

done” (Wolff, p. 79)

Recap: Moral Considerations

Ethical Conduct of Work in International Health

Section B

Health and Human Rights, Vol. 11, No. 1. (2009): pp. 87–92

Setting the Stage

!  Eradication: the permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts so that intervention measures are no longer needed

International Health Context

4 Source: Dowdle, W. R. (1998). The principles of disease elimination and eradication. Bull World Health Organ, 76, 22–25.

!  By definition, eradication as a goal—“the permanent reduction to zero of the worldwide incidence of infection”—is global in scope and affects future

!  Yet the achievement of the goal entails comprehensive participation by every affected local constituency in the present

International Health Context

!  This is “a public-private partnership led by national governments and spearheaded by” WHO, Rotary International, US CDC, and UNICEF

!  Launched: 1988

!  Goal: “to eradicate polio worldwide”

!  International investment to date: >$8 billion

!  Number of children immunized to date: >2.5 billion

Global Polio Eradication Initiative (GPEI)

!  “Polio remains endemic in three countries—Afghanistan, Nigeria and Pakistan.”

!  “Until poliovirus transmission is interrupted in these countries, all countries remain at risk of importation of polio, especially in the ‘poliovirus importation belt’ of countries from west Africa to the Horn of Africa.”

Countries of Greatest Interest

!  Focus on pages 89–91 of Rubincam & Naysmith

!  Using concepts from Wolff, consider the following: 1.  What moral basis could there be for GPEI? 2.  What moral basis could there be for the 2003 community boycott and the 2008

community interference with GPEI activities? 3.  Is there a conflict of moral reasoning between GPEI and community actors? 4.  How would you act as a GPEI leader? As a community leader? For what moral

reasons?

Questions for Reflection

!  The case illustrates ethical questions—how to do right by people in specific situations—that often arise in work related to international health

!  You can use moral concepts to ... !  Identify important reasons why actors might be doing what they do; and !  Analyze complex situations where moral reasons vary among different actors; and !  Listen, learn, and think about how to resolve tensions or conflicts that may involve

differing moral viewpoints

Concluding Comments

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