Jay Zameska

This paper aims to specify causal pluralism through considerations from public health ethics for causal analyses featuring social determinants of health. We will argue that choosing approaches to causality within a pluralistic framework can be informed by ethical considerations. More specifically, we will show how different conceptions of justice set different explanatory demands and how those demands constrain which causal concepts are appropriate to use. We will particularly illustrate this by examining how these causal concepts differentially support competing theories of justice, namely distributive and relational conceptions of justice, in the context of understanding and addressing health inequalities linked to social determinants like income inequality. We will further argue that this strategy can be employed more broadly to different causal concepts and ethical priorities.

One prominent line of support for nudging in screening programs is the claim that nudging can help ‘bad choosers’ — that is, it can help some patients make choices more in line with their own values and preferences. In this article, I argue that due to the presence of epistemic risk in many screening programs, the argument that nudging can help ‘bad choosers’ should be revised or rejected. Expanding on the work of Biddle, J. B. 2020. Epistemic risks in cancer screening: Implications for ethics and policy. Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences 79: 101200.), I argue that epistemic risk undermines the argument that nudging can help to promote patient autonomy in the context of screening. Specifically, I argue that epistemic risk results in the inclusion of non-patient values and preferences in the screening process, which challenges the claim that nudging can help patients make choices more in line with their own values and preferences. I present four reasons to think epistemic risk undermines the argument in this way: (1) conflicting values; (2) lack of transparency; (3) limited autonomy in opting out; (4) unjustified manipulation. The presence of epistemic risk in screening programs means that nudging may not always be an effective means of promoting patient autonomy and informed consent. As such, epistemic risk poses significant challenges to at least one ethical justification of nudging in screening programs, and raises further questions about the role of nudging in promoting patient decision-making.

The Covid-19 pandemic resulted in school closures around the world, leaving lasting negative impacts on many children. Given that such closures are justified public health measures, this raises the question of compensating children for school closures. In this article I address the question of compensation from the perspective of a popular theory of justice: luck egalitarianism. In doing so, I examine a problem with applying luck egalitarianism to children, called the agency assumption. I then argue this assumption results in a dilemma for luck egalitarianism and suggest how this dilemma can be overcome. I argue that the resulting form of luck egalitarianism reveals something interesting about compensating children for school closures: luck egalitarianism requires us to address all bases of justice-relevant inequality among children—Covid-19-related and beyond. Although much of the current discussion of compensating children for such closures has focused narrowly on the need to make up for lost instruction time or to prevent reductions in educational achievement, I argue that a luck egalitarian conception of justice requires us to go beyond merely compensating children for educational losses and instead aim for radical equality in education.

One proposal to significantly reduce cardiovascular disease is the idea of administering a ‘polypill’—a combination of drugs that reduce the risk of heart disease and carry few side effects—to everyone over the age of 55. Despite their promise, population strategies like the polypill have not been well-accepted. In this article, I defend the polypill by appealing to fairness. The argument focuses on the need to fairly distribute the costs to individuals. While the fact that population strategies like the polypill impose minor costs on everyone has primarily been used to criticize such strategies, I argue that it gives us a reason to support them. I argue that implementing a population strategy with the polypill contributes to the public good of ‘health system capacity’. I then explain that public goods have widely accepted obligations: they carry an obligation to fairly distribute the costs of the goods and prevent free-riding. Thus, we have at least one pro tanto moral reason to implement the polypill. As such, this article challenges the current literature on the topic, which has largely held adopting population strategies like the polypill to be unjustifiable.

In this commentary on Torbjörn Tännsjö’s Setting Health-Care Priorities, I argue that sufficientarianism provides a valuable perspective in considering how to set health care priorities. I claim that pace Tännsjö, sufficientarianism does offer a distinct alternative to prioritarianism. To demonstrate this, I introduce sufficientarianism and distinguish two forms: Tännsjö’s “weak sufficientarianism” and an alternative strong form of sufficientarianism that I call “revised lexical sufficientarianism.” I raise a problem for Tännsjö’s sufficientarianism, and advocate for the revised view on this basis. I then demonstrate that in the area of population ethics, the revised view outperforms the other views Tännsjö considers. As such, I aim to demonstrate that sufficientarianism — understood as its own theory and not just as a form of prioritarianism — offers unique advantages in population ethics, and would have been a valuable complement to the other theories Tännsjö considers.