Jessica Fahlquist

Risks, including health and technological, attract a lot of attention in modern societies, from individuals as well as policy-makers. Human beings have always had to deal with dangers, but contemporary societies conceptualise these dangers as risks, indicating that they are to some extent controllable and calculable. Conceiving of dangers in this way implies a need to analyse how we hold people responsible for risks and how we can and should take responsibility for risks. Moral Responsibility and Risk in Societycombines philosophical discussion of different concepts and notions of responsibility with context-specific applications in the areas of health, technology and environment. The book consists of two parts addressing two crucial aspects of risks and responsibility: holding agents responsible, i.e. ascribing and distributing responsibility for risks and taking responsibility for risk. More specifically, the book discusses the values of fairness and efficacy in responsibility distributions and makes distinctions between backward-looking and forward-looking responsibility as well as individual and collective responsibility. Additionally, it analyses what it means to take responsibility for technological risks, conceptualizing this kind of responsibility as a virtue, and furthermore, explores the notion of responsible risk communication and the implications for adult-child relationships. This book will be of great interest to students and scholars of environmental ethics, bioethics, public health ethics, engineering ethics, philosophy of risk and moral philosophy.

The COVID-19 pandemic during 2020–2022 raised ethical questions concerning the balance between individual autonomy and the protection of the population, vulnerable individuals and the healthcare system. Pediatric COVID-19 vaccination differs from, for example, measles vaccination in that children were not as severely affected. The main question concerning pediatric vaccination has been whether the autonomy of parents outweighs the protection of the population. When children are seen as mature enough to be granted autonomy, questions arise about whether they have the right to decline vaccination and who should make the decision when parents disagree with each other and/or the child. In this paper, I argue that children should be encouraged to not only take responsibility for themselves, but for others. The discussion of pediatric vaccination in cases where this kind of risk–benefit ratio exists extends beyond the 2020–2022 pandemic. The pandemic entailed a question that is crucial for the future of public health as a global problem, that is, to what extent children should be seen as responsible decision-makers who are capable of contributing to its management and potential solution. I conclude that society should encourage children to cultivate such responsibility, conceived as a virtue, in the context of public health.

Traditionally, the management of technology has focused on the stages before or after development of technology. In this approach the technology itself is conceived as the result of a deterministic enterprise; a result that is to be either rejected or embraced. However, recent insights from Science and Technology Studies (STS) have shown that there is ample room to modulate technology during development. This requires technology managers and engineering ethicists to become more involved in the technological research rather than assessing it from an outsider perspective. Instead of focusing on the question whether or not to authorize, approve, or adopt a certain technology or on the question of who is to blame for potential mistakes, the guiding question in this new approach is how research is to be carried out.

Most sources providing information on infant feeding strongly recommend breastfeeding. The WHO and UNICEF recommend that women breastfeed their babies and that health professionals promote breastfeeding. This creates severe pressure on women to breastfeed, a pressure which is ethically questionable since many women have physical or emotional problems with breastfeeding. In this article, we use insights from the ethics of risk to criticize the current breastfeeding policy. We argue that there are problems related to balancing aggregate wellbeing versus individual wellbeing, that not enough attention is paid to alternatives, that women’s emotions and their need for free choice should be considered and that issues of equity are currently overlooked. We also criticize the way scientific information is presented in the current policy. We conclude that the official sources of information on infant feeding should be revised. Information should be more nuanced and designed to support mothers, and families in making a free choice on what is the best way to feed their babies

Women who suffer from fertility issues often use in vitro fertilization (IVF) to realize their wish to have children. However, IVF has its own set of strict administration rules that leave the women physically and emotionally exhausted. Feeling alienated and frustrated, many IVF users turn to internet IVF-centered forums to share their stories and to find information and support. Based on the observation of Dutch and Greek IVF forums and a selection of 109 questionnaires from Dutch and Greek IVF forum users, we investigate the reasons why users of IVF participate in online communities centered on IVF, their need for emotional expression and support, and how they experience and use the information and support they receive through their participation in the online community. We argue that the emotional concerns expressed in such forums should be taken into account by health care ethics committees for IVF-related matters in order to promote more patient-oriented care and support for women going through IVF

The general aim of this thesis is to present and analyse traffic safety from an ethical perspective and to explore some conceptual and normative aspects of moral responsibility. Paper I presents eight ethical problem areas that should be further analysed in relation to traffic safety. Paper II is focused on the question of who is responsible for traffic safety, taking the distribution of responsibility adopted through the Swedish policy called Vision Zero as its starting point. It is argued that a distinction should be made between backwardlooking and forward-looking responsibility and that Vision Zero should be understood in terms of this distinction. Paper III discusses responsibility ascriptions in relation to public health problems like obesity and lung cancer. It is argued that what makes discussions about who is responsible for such problems complicated is that we have two aims when ascribing responsibility to someone. First, we want responsibility ascriptions to be fair and morally justified. Second, we also want to achieve progress and solve problems through ascribing responsibility to someone. It is argued that the two aims influence debates concerning who is responsible for problems like obesity and lung cancer and that we should attempt at striking a balance that is both perceived as fair and that is efficient. Paper IV discusses two potential arguments against the suggestion that alcohol interlocks should be mandatory in all cars, namely 1) that it displaces the responsibility of individual drivers, and 2) that it constitutes a paternalistic interference with drivers. The first objection is found unconvincing, while the second only has limited bite and may be neutralized if paternalism is accepted for the sake of greater net liberty. It is argued that if technological development can make mandatory interlocks cost-efficient, the policy seems a commendable public health measure. In Paper V, the question discussed is to what extent individuals should be ascribed moral responsibility for the environmentally damaging consequences of their actions. It is argued that responsibility depends on the reasonableness of the alternatives open to an individual when acting. The lack of reasonable alternatives should reduce the degree of individual responsibility.

Due to the alarming rise of antibiotic resistance, medically unwarranted use of antibiotics has assumed new moral significance. In this paper, a thematic content analysis of focus group discussions was conducted to explore lay people’s views on the moral challenges posed by antibiotic resistance. The most important finding is that lay people are morally sensitive to the problems entailed by antibiotic resistance. Participants saw the decreasing availability of effective antibiotics as a problem of justice. This involves individual as well as collective moral responsibility. Yet, holding agents responsible for their use of antibiotics involves varying degrees of demandingness. In our discussion, these findings are related to the contemporary ethical debate on antibiotic resistance and two proposals for the preservation of antibiotic effectiveness are compared to and evaluated against participants’ views.

The actions performed by individuals, as consumers and citizens, have aggregate negative consequences for the environment. The question asked in this paper is to what extent it is reasonable to hold individuals and institutions responsible for environmental problems. A distinction is made between backward-looking and forward-looking responsibility. Previously, individuals were not seen as being responsible for environmental problems, but an idea that is now sometimes implicitly or explicitly embraced in the public debate on environmental problems is that individuals are appropriate targets for blame when they perform actions that are harmful to the environment. This idea is criticized in this paper. It is argued that instead of blaming individuals for performing actions that are not environmentally friendly we should ascribe forward-looking responsibility to individuals, a notion that focuses more on capacity and resources than causation and blameworthiness. Furthermore, it is important to emphasize that a great share of forward-looking responsibility should also be ascribed to institutional agents, primarily governments and corporations. The urge to ascribe forward-looking responsibility to institutional agents is motivated by the efficiency aim of responsibility distributions. Simply put, if responsibility is ascribed to governments and corporations there is a better chance of creating a society in which the opportunities to act in an environmentally friendly way increase.

In contrast to medical care, which is focused on the individual patient, public health is focused on collective health. This article argues that, in order to better protect the individual, discussions of public health would benefit from incorporating the insights of virtue ethics. There are three reasons to for this. First, the collective focus may cause neglect of the effects of public health policy on the interests and rights of individuals and minorities. Second, whereas the one-on-one encounters in medical care facilitate a compassionate and caring attitude, public health involves a distance between professionals and the public. Therefore, public health professionals must use imagination and care to evaluate the effects of policies on individuals. Third, the relationship between public health professionals and the people who are affected by the policies they design is characterized by power asymmetry, demanding a high level of responsibility from those who wield them. Against this background, it is argued that public health professionals should develop the virtues of responsibility, compassion and humility. The examples provided, i.e. breastfeeding information and vaccination policy, illustrate the importance of these virtues, which needed for normative as well as instrumental reasons, i.e. as a way to restore trust.

Public health ethics is commonly analyzed within a consequentialist or rights-based perspective, but recent approaches explore public health from a virtue ethical perspective. Rozier focuses on the virtues of individual members of the public and I discuss public health professionals. MacKay emphasizes the role of the collective level, the practice and social structure of public health. The structure can be important in two ways. First, it potentially affects the cultivation of the virtues of individuals. Second, the structure itself could have virtues. MacKay defends the latter notion and argues that structures become objective reality that is non-reducible to individuals. She implicitly describes public health as an actor, as having hopes and aspirations. MacKay’s account is an interesting contribution to the field. I agree with that the social structure is important but argue that it is primarily important in relation to the cultivation of individual virtues. Public health is not an agent and if it is described as such, it needs a supporting argument concerning moral group agency. I argue that there are no collectives without individuals. Future studies should focus on the links between the individual and social levels and discuss which virtues are the most important.

Drink driving causes great suffering and material destruction. The alcohol interlock promises to eradicate this problem by technological design. Traditional counter-measures to drink driving such as policing and punishment and information campaigns have proven insufficient. Extensive policing is expensive and intrusive. Severe punishment is disproportionate to the risks created in most single cases. If the interlock becomes inexpensive and convenient enough, and if there are no convincing moral objections to the device, it may prove the only feasible as well as the only justifiable solution to the problem of drink driving. A policy of universal alcohol interlocks, in all cars, has been proposed by several political parties in Sweden and is supported by the National Road Administration and the 2006 Alcohol Interlock Commission. This article assesses two possible moral objections to a policy of universal interlocks: (i) that it displaces the responsibility of individual drivers and (ii) that it constitutes a paternalistic interference with drivers. The first objection is found unconvincing, while the second has only limited bite and may be neutralized if paternalism is accepted for the sake of greater net liberty. Given the expected technological development, the proposed policy seems a commendable health promotion measure for the near future

In some situations in which undesirable collective effects occur, it is very hard, if not impossible, to hold any individual reasonably responsible. Such a situation may be referred to as the problem of many hands. In this paper we investigate how the problem of many hands can best be understood and why, and when, it exactly constitutes a problem. After analyzing climate change as an example, we propose to define the problem of many hands as the occurrence of a gap in the distribution of responsibility that may be considered morally problematic. Whether a gap is morally problematic, we suggest, depends on the reasons why responsibility is distributed. This, in turn, depends, at least in part, on the sense of responsibility employed, a main distinction being that between backward-looking and forward-looking responsibility.