Marcel Verweij

ABSTRACT:Many companies engage in dialogue with nongovernmental organizations about societal issues. The question is what a regulative ideal for such dialogues should be. In the literature on corporate social responsibility, the Habermasian notion of communicative action is often presented as a regulative ideal for stakeholder dialogue, implying that actors should aim at consensus and set strategic considerations aside. In this article, we argue that in many cases, communicative action is not a suitable regulative ideal for dialogue between companies and NGOs. We contend that there is often an adversarial element in the relation between companies and NGOs, and that an orientation towards consensus can be in tension with this adversarial relation. We develop an alternative approach to stakeholder dialogue called ‘agonistic deliberation.’ In this approach, conflict and strategic considerations play a legitimate and, up to a certain point, desirable role.

Due to its emphasis on experiential interests, animal ethics tends to focus on individuals as the sole unit of moral concern. Many issues in animal ethics can be fruitfully analysed in terms of obligations towards individual animals, but some problems require reflection about collective dimensions of animal life in ways that individualist approaches can’t offer. Criticism of the individualist focus in animal ethics is not new; it has been put forward in particular by environmental ethics approaches. However, the latter tend to be so far removed from the concerns of animal ethicists that both groups talk at cross purposes. We think the gap between environmental and animal ethics could be bridged by on the one hand focusing more on the collective dimensions of our concerns with animals - after all, individuals are constituted by the collective of which they are a part - and on the other hand, by showing that moral status can also be attributed to groups in an indirect way, related to the moral status of their individual members. In our paper we explore various ways of conceptualising the moral relevance of collectiveness in animal life. We draw on insights from public health ethics, as this field of inquiry has also developed - at least partly—in response to individualist approaches in human bioethics, creating more room for recognizing the value of population health, interpersonal relations, solidarity, and ways in which a collective is constituted

In this article, we argue that apart from evaluating the causes and the social determinants of health inequalities, an evaluation of the effects of health inequalities is due. For this, we propose the ideal of relational equality as an evaluative framework, and test to what extent health inequalities threaten this ideal of a society of equals. We identify three ways in which they do and argue that these risks are especially great for those lower down the socio-economic strata. We thus conclude that equality in health is instrumental to social justice, and that socio-economic inequalities in health are not only unjust due to their causes but also due to their consequences. We continue to argue that our instrumental approach opens a perspective to mitigate the identified injustices by changing society, rather than reducing inequalities in health, and argue that this is an advantage in the light of the realistic assumption that of the socio-economic health inequalities will persist. The article thus offers a complementary approach to both the evaluation and the mitigation of the injustice of socio-economic inequalities in health.

Many countries have implemented infection control measures directed at carriers of multidrug-resistant organisms. To explore the ethical implications of these measures, we analyzed 227 consultations about multidrug resistance and compared them with the literature on communicable disease in general. We found that control measures aimed at carriers have a range of negative implications. Although moral dilemmas seem similar to those encountered while implementing control measures for other infectious diseases, 4 distinct features stand out for carriage of multidrug-resistant organisms: carriage presents itself as a state of being; carriage has limited relevance for the health of the carrier; carriage has little relevance outside healthcare settings; and antimicrobial resistance is a slowly evolving threat on which individual carriers have limited effect. These features are of ethical relevance because they influence the way we traditionally think about infectious disease control and urge us to pay more attention to the personal experience of the individual carrier.

Whereas theories on health generally argue in favor of one specific concept, we argue that, given the variety of health practices, we need different concepts of health. We thus approach health concepts as a Wittgensteinian family of thick concepts. By discussing five concepts of health offered by theory, we argue that all capture something that seems relevant when we talk and think about health. Classifying these concepts reveals their family resemblances: each of these concepts differs from the others in at least one respect and resembles the others in several respects. Moreover, our classification shows that “health” always both describes a condition and evaluates that condition at the same time. Having both descriptive and evaluative dimensions, we can see health concepts as “thick concepts.” It is because of this evaluative dimension that it is important to reflect on the question of what understanding of health guides specific practices. We show that the distinctions revealed by our classification can serve as a conceptual toolbox for reflection on the assumptions and purposes of particular health practices. Finally, we illustrate how such reflection could work out by briefly exploring three specific health practices.

ABSTRACTIn this article, we explore the debate on corporate citizenship and the role of business in global governance. In the debate on political corporate social responsibility it is assumed that under globalization business is taking up a greater political role. Apart from economic responsibilities firms assume political responsibilities taking up traditional governmental tasks such as regulation of business and provision of public goods. We contrast this with a subsidiarity-based approach to governance, in which firms are seen as intermediate actors who have political co-responsibilities in society endowed upon them by national governmental institutions. We argue that both approaches face conceptual and empirical problems, and do not make clear the content and scope of political corporate responsibility. Based on Iris Marion Young’s account of political responsibility we argue that corporate actors and governmental actors have a shared responsibility to tackle societal problems. Taking political corporate responsibility not only entails engaging in private action or engaging in public–private partnerships, but it also includes aiding governmental actors to remedy injustice or even create public institutions where they do not yet exist. By adding this perspective we contribute to the debate on responsibility in corporate citizenship and clarify the political role business can play in global governance.

A Dutch medical student has the potentially more virulent Panton-Valentine leukocidin form of MRSA colonization yet shows no signs or symptoms of infection. More than a year ago, a routine MRSA screening of health care personnel providing care for MRSA-positive patients detected the colonization. Since then, the student has been treated intensively but unsuccessfully in an attempt to decolonize her. During this decolonization period, the medical student was barred from performing patient-related interventions, temporarily interrupting her medical residency. After initial treatment with mupirocin nasal ointment and antibiotics proved ineffective, a more stringent hygiene regime was added that included hand, nose, hair, and body scrubbing with disinfecting soap. Additional precautions included simultaneous treatment of household members and disinfection of the family home. Despite these efforts, her MRSA status has remained positive. WIP guideline s bar any health care worker diagnosed with MRSA from performing patient-related interventions. Unable to complete the residency requirement of at least 1 year of patient care, the medical student was advised to pursue a career in another profession.

Objectives: Efficient procedures for obtaining informed (proxy) consent may contribute to high influenza vaccination rates in nursing homes. Yet are such procedures justified? This study’s objective was to gain insight in informed consent policies in Dutch nursing homes; to assess how these may affect influenza vaccination rates and to answer the question whether deviating from standard informed consent procedures could be morally justified. Design: A survey among nursing home physicians. Setting & Participants: We sent a questionnaire to all (356) nursing homes in the Netherlands, to be completed by one of the physicians. Results: We received 245 completed questionnaires. As 21 institutions appeared to be closed or merged into other institutions, the response was 73.1% (245/335). Of all respondents 81.9% reported a vaccination rate above 80%. Almost 50% reported a vaccination rate above 90%. Most respondents considered herd immunity to be an important consideration for institutional policy. Freedom of choice for residents was considered important by almost all. Nevertheless, 106 out of 245 respondents follow a tacit consent procedure, according to which vaccination will be administered unless the resident or her proxy refuses. These institutions show significantly higher vaccination rates (p < 0.03). Conclusions: In our discussion we focus on the question whether tacit consent procedures can be morally justifiable. Such procedures assume that vaccination is good for residents either as individuals or as a group. Even though this assumption may be true for most residents, there are good reasons for preferring express consent procedures.

Tolerance for blood transfusion risks is very low, as evidenced by the implementation of expensive blood tests and the rejection of gay men as blood donors. Is this low risk tolerance supported by the precautionary principle, as defenders of such policies claim? We discuss three constraints on applying the precautionary principle and show that respecting these implies tolerating certain risks. Consistency means that the precautionary principle cannot prescribe precautions that it must simultaneously forbid taking, considering the harms they might cause. Avoiding counterproductivity requires rejecting precautions that cause more harm than they prevent. Proportionality forbids taking precautions that are more harmful than adequate alternatives. When applying these constraints, we argue, attention should not be restricted to harms that are human caused or that affect human health or the environment. Tolerating transfusion risks can be justified if available precautions have serious side effects, such as high social or economic costs.

There has been increased interest in the potential of maternal immunisation to protect maternal, fetal, and infant health. Maternal tetanus vaccination is part of routine antenatal care and immunisation campaigns in many countries, and it has played an important part in the reduction of maternal and neonatal tetanus. Additional vaccines that have been recommended for routine maternal immunisation include those for influenza and pertussis, and other vaccines are being developed. Maternal immunisation is controversial since regulators, professionals, and the public are often reluctant to accept pharmaceutical interventions during pregnancy. So far, little attention has been given to the ethics of vaccination during pregnancy. In this Personal View we argue that maternal immunisation should be offered in response to concrete, severe risks of disease for mother and child, and we explain how this requirement of serious risk can be used to guide ethical decision-making about maternal immunisation.

In spite of the fact that in recent years many steps have been taken in the control of zoonotic diseases, we are still confronted with recent outbreaks of, for example Ebola and Avian Flu and with public debates on the preferred way to deal with zoonoses. Such debates can easily get polarised. Therefore, we argue that a more integrated approach is needed. In this paper we propose an integration on three levels. First, the One Health initiative could serve a fruitful approach to take the interrelatedness of human and animal health into account. Second, we argue that it might be fruitful to approach societal controversies about how societies should respond to zoonotic risks not by focusing on conflicting interests, but as conflicts between broadly shared values. Finally, an effective approach of and a discussion on zoonoses require a more sophisticated view on moral responsibilities, which goes beyond the level of the question ‘who is to blame?’ for a specific outbreak. In this paper we claim that although finding acceptable and well-justified policies will remain a difficult task, these three steps towards a pluralistic approach to thinking about prevention of and response to zoonosis outbreaks may create possibilities to overcome conflicts.

Due to its emphasis on experiential interests, animal ethics tends to focus on individuals as the sole unit of moral concern. Many issues in animal ethics can be fruitfully analysed in terms of obligations towards individual animals, but some problems require reflection about collective dimensions of animal life in ways that individualist approaches can’t offer. Criticism of the individualist focus in animal ethics is not new; it has been put forward in particular by environmental ethics approaches. However, the latter tend to be so far removed from the concerns of animal ethicists that both groups talk at cross purposes. We think the gap between environmental and animal ethics could be bridged by focusing more on the collective dimensions of our concerns with animals. In our paper we explore various ways of conceptualising the moral relevance of collectiveness in animal life. We draw on insights from public health ethics, as this field of inquiry has also developed – at least partly – in response to individualist approaches in human bioethics, creating more room for recognizing the value of population health, interpersonal relations, solidarity, and ways in which a collective is constituted.

Current thinking on the development of molecular microbial characterisation techniques in public health focuses mainly on operational issues that need to be resolved before incorporation into daily practice can take place. Notwithstanding the importance of these operational challenges, it is also essential to formulate conditions under which such microbial characterisation methods can be used from an ethical perspective. The potential ability of molecular techniques to show relational patterns between individuals with more certainty brings a new sense of urgency to already difficult ethical issues associated with privacy, consent and a moral obligation to avoid spreading a disease. It is therefore important that professionals reflect on the ethical implications of using these techniques in outbreak management, in order to be able to formulate the conditions under which they may be applied in public health practice

The growing prevalence of obesity and related conditions such as Type II diabetes is held by many to be a major public health problem in developed countries, and increasingly in developing countries as well. If we wish to tackle this problem, it will be a major task. Individuals will have to change their consumption and exercise patterns, companies will have to improve the products they make and how they market them, nutrition experts and communities will have to redefine what is acceptable and desirable in food practices and governments will have to lead and promote such societal-level changes in many different fields, including food policy, urban design, educational policies, agricultural subsidies and tax breaks, etc. This is all very difficult to achieve. In many people’s view, government action aiming at social change will be especially controversial and meet some resistance. New York …

Given the ethical aspects of vaccination policies and current threats to public trust in vaccination, it is important that governments follow clear criteria for including new vaccines in a national programme. The Health Council of the Netherlands developed such a framework of criteria in 2007, and has been using this as basis for advisory reports about several vaccinations. However, general criteria alone offer insufficient ground and direction for thinking about what the state ought to do. In this paper, we present and defend two basic ethical principles that explain why certain vaccinations are the state's moral-political responsibility, and that may further guide decision-making about the content and character of immunisation programmes. First and foremost, the state is responsible for protecting the basic conditions for public health and societal life. Secondly, states are responsible for promoting and securing equal access to basic health care, which may also include certain vaccinations. We argue how these principles can find reasonable support from a broad variety of ethical and political views, and discuss several implications for vaccination policies

Some screening tests for donor blood that are used by blood services to prevent transfusion-transmission of infectious diseases offer relatively few health benefits for the resources spent on them. Can good ethical arguments be provided for employing these tests nonetheless? This paper discusses—and ultimately rejects—three such arguments. According to the ‘rule of rescue’ argument, general standards for cost-effectiveness in healthcare may be ignored when rescuing identifiable individuals. The argument fails in this context, however, because we cannot identify beforehand who will benefit from additional blood screening tests. On the ‘imposed risk’ argument, general cost-effectiveness standards do not apply when healthcare interventions impose risks on patients. This argument ignores the fact that imposing risks on patients is inevitable in healthcare and that these risks can be countered only within reasonable limits. Finally, the ‘manufacturing standard’ argument premises that general cost-effectiveness standards do not apply to procedures preventing the contamination of manufactured medical products. We contend that while this argument seems reasonable insofar as commercially manufactured medical products are concerned, publicly funded blood screening tests should respect the standards for general healthcare. We conclude that these particular arguments are unpersuasive, and we offer directions to advance the debate.

BACKGROUND: The availability of costly safety measures against transfusion-transmissible infections forces Western countries to confront difficult ethical questions. How to decide about implementing such measures? When are such decisions justified? As a preliminary to addressing these questions, we assessed which concerns shape actual donor blood safety policymaking in five Western countries. STUDY DESIGN AND METHODS: Our qualitative study involved determining which issues had been discussed in advisory committee meetings and capturing these issues in general categories. Appropriate documents were identified in collaboration with local decision-making experts in Canada, Germany, the Netherlands, the United States, and the United Kingdom. The introduction of hepatitis B virus nucleic acid testing and selected measures against variant Creutzfeldt-Jakob disease, West Nile virus, and Q-fever were chosen as cases representing decision-making on safety measures with high costs and low or uncertain added safety. RESULTS: A broad inventory of concerns was established, including: 1) nine categories of advantages and disadvantages of candidate safety policies; 2) six kinds of difficulties in assessing risks and forecasting the effects of safety policies; 3) 13 decision-making principles; and 4) six kinds of practical barriers hampering the translation of candidate policies into decisions. CONCLUSION: Blood safety policymaking involves a wide variety of competing concerns, and approaches to reconcile these considerations are themselves contested. Developing a systematic decision-making approach requires ethical reflection on, among others, reasonable costs of safety and the value of transparency in public policy.

Preventive medicine is sometimes criticised as it contributes to medicalization of normal life. The concept ‘medicalization’ has been introduced by Zola to refer to processes in which the labels ‘healthy’ and ‘ill’ are made relevant for more and more aspects of human life. If preventive medicine contributes to medicalization, would that be morally problematic? My thesis is that such a contribution is indeed morally problematic. The concept is sometimes used to express moral intuitions regarding the practice of prevention and health promotion. Through analysis of these intuitions as well as some other moral concerns, I give an explication of the moral problems of medicalization within the context of preventive medicine.