Marcel Verweij

The curious philosopher often answers questions by raising further, more fundamental questions. How can this be fruitful and practical in the context of Wageningen University? Philosophy offers critical reflection on conceptual and normative assumptions in science and society, and that is necessary for responsible practices. I illustrate this by analyzing the concept of quality of life – a key value in the mission of our university – and by questioning current debates about responsibility for health

The rule of rescue holds that special weight should be given to protecting the lives of assignable individuals in need, implying that less weight is given to considerations of cost-effectiveness. This is sometimes invoked as an argument for funding or reimbursing life-saving treatment in public healthcare even if the costs of such treatment are extreme. At first sight one might assume that an individualist approach to ethics—such as Scanlon’s contractualism—would offer a promising route to justification of the rule of rescue. In this chapter I argue that contractualism cannot endorse the rule of rescue, whereas a collectivist approach that appeals to group solidarity would offer support for rescue cases. The argument, however, has its limitations, and though solidarity is of central concern in shaping public healthcare, there are good reasons for not endorsing the rule of rescue as a moral basis for allocating scarce resources in clinical care.

Thanks to developments in genomics,dietary recommendations adapted to genetic riskprofiles of individual persons are no longerscience fiction. But what are the consequencesof these diets? An examination of possibleimpacts of genetically tailor-made diets raisesmorally relevant concerns that are analogous to(medical-ethical) considerations aboutscreening and testing. These concerns oftengive rise to applying norms for informedconsent and for the weighing of burdens andbenefits. These diets also have a broaderimpact, especially because food patterns arefull of personal, social and cultural meanings.Diets will change one's food patterns and one'sattitude towards food, and this may implychanges in one's identity. We argue that suchan impact does not necessarily raise moralproblems. Moral concerns are, however, relevantif collective values and shared meanings infood practices are at issue. Therefore, thedevelopment of genetically tailor-made dietsdoes not merely require emphasis on weighingpersonal benefits and burdens and on informedconsent. It also asks for attention to andmoral reflection on the collective valuesinvolved in food practices.

One of the societal problems in a new influenza pandemic will be how to use the scarce medical resources that are available for prevention and treatment, and what medical, epidemiological and ethical justifications can be given for the choices that have to be made. Many things may become scarce: personal protective equipment, antiviral drugs, hospital beds, mechanical ventilation, vaccination, etc. In this paper I discuss two general ethical principles for priority setting (utility and equity) and explain how these principles will often point in diverging directions. Moreover, each of these principles can be understood in different, again often competing, ways. Notwithstanding these controversies and conflicts, in the context of pandemic response there are at least some points of convergence: several policies can be justified by appeal to different ethical principles and theories. Convergence may be found with respect to a focus on saving the most lives (instead of other aggregative accounts); giving priority antiviral prophylaxis and therapy for life-saving pandemic responders; and, partly depending on epidemiology of the pandemic, to prioritise vaccination of children. Although decision-making about access to intensive care will involve choices with immediate tragic implications, the ethical complexity of these choices is relatively modest (although decisions will not be easy): there are persuasive moral reasons for giving priority to patients who are expected to benefit most within the shortest time. Finally, in the last section I tentatively argue that constraints on people’s freedom, as necessary for an effective public health approach, may support giving somewhat more weight to saving the most lives, than to concerns of equity.