Terms and Concepts

• Love (Aquinas)

  • love is the willingness and act for the good

• Two Feet of Love in Action

  • this social teaching calls on the conscience to recognize and fulfill the obligations of justice and charity in society

    • social justice: remove root causes and improve structures

    • charitable works: meet basic needs and individuals

• Core question of virtue ethics

  • Moral = Virtue | “Whom should I be?”

    • goodness: person striving for the good

    • badness: person not striving for the good

• Core question of deontology

  • Moral = Rule | “What’s the rule?”

• Core question of utilitarianism

  • Moral = Pleasure & Pain | “What’s the consequence?”

• Broad definition of health in Ashley and O’Rourke

  • Human health in a broad meaning is the optimal and integrated functioning of the person to meet biological, psychological, social, and creative needs.

  • Human flourishing

• Broad definition of public health in Bernheim et al.

  • Public health: what we do as a society to ensure conditions in which people can be healthy

    • involves subsidiarity and placing that into action

    • goals of PH: (1) Protect, (2) Prevent, (3) Promote

• Public Philosophy

  • shared values, principles, norms, and their expression in public life

    • values are felt & internal experience (experience human worth) → principle name experience (principle “human dignity”) → norm is the rule for whom to be, what to do, and what not to do (exist to protect principle and value)

• Absolutist

  • “asserts that one norm is superior to and always triumphs over certain other norms”

• Contextualist

  • balances PH goals against rules of privacy to determine which is weightier in a specific situation - i.e., no objective order, standard, or priority

• Presumptive

  • presumes default priorities for some norms, but priorities are not absolute

• Two criteria for public health decision-making in a public forum

  • Public health decision-making in the public forum must be evidence-based and value-based

• Definition of politics and importance to human dignity

  • politics: an activity that structures a community

  • human dignity: dignity can be realized and protected only in the community

    • as for the state, its whole realization of the common good in the temporal order

    • the human person is not only sacred but also social. How we organize our society - in economics and politics, in law and policy - directly affects human dignity and the capacity of individuals to grow in community

    • responsible citizenship is a virtue and participation in political life is a moral obligation

• Rights and duties (positive or negative)

  • Catholic tradition claims everything needed to protect human dignity & ensure human flourishing → person has the right to live.. not a commodity, a right

    • positive: right to

    • negative: right not to be

  • Duties owed (created by, for, to love - solidarity) “order of charity”

    • positive is the responsibility to help one realize one's right

    • negative is the responsibility to not violate rights

• Freedom (positive or negative)

  • freedom: act without restraint

    • negative freedom from active limitations that prevent choice - e.g., I can’t go to the doctor because you are physically stopping me

    • positive freedom for flourishing that empowers choice - .e.g, I can’t go to the doctor because my employer withholds benefits. Nobody is actively stopping me (negative freedom), but I’m not sufficiently free to choose to flourish. Requires basic conditions (rights and duties!)

• Solidarity

  • Justice requires solidarity “to commit oneself to the common good; that is to say to the good of all and of each individual because we are all responsible for all“

• Common Good

  • common good is adequate housing, accessible jobs, quality education, child care, and health care, etc.

    • Justice giving what’s due: commutative justice, contributing justice, and distributive justice

  • social justice: participation

  • commutative justice is the fundamental fairness in all agreements and exchanges between individuals or groups

  • contribution justice is when the persons must be active and productive participants in the life of society and society must enable them; e.g., agency → question equality versus equity

  • distributive justice requires allocations of resources to those whose basic materials are unmet; e.g., welfare

• Purpose of the State in Catholic Social Teaching

  • in Catholic tradition, the state exists to promote & protect the common good

    • state should not intervene if rights are secure and duties are fulfilled - the lowest possible

    • state should intervene if rights are violated and duties are not fulfilled - the highest necessary

• Subsidiarity

  • state intervention at the lowest possible but highest necessary level of society to protect when the common good needs to be protected and promoted

  • e.g., Intervention Ladder

• Justice

  • renders to each one their due

    • at a minimum, justice protects rights and fulfills duties

    • option for the poor, vulnerable, and marginalized

• Libertarian justice on rights or duties and implications for healthcare

  • libertarian: justice as entitlement to holding based on laws of the minimal state

    • rights, no positive duties

    • healthcare is not a right but people may voluntarily act = absolutist = health care as a market = negative duties but no positive (can’t compel - that’ll violate rights)

  • people have minimum positive and negative rights, denies the premise of duties

• Catholic justice on rights or duties and implications for health care

  • Catholicism “rejects the notion that a free market automatically produces justice” - that it protects rights and ensures fulfillment of duties

    • “it is the task of the State to provide for the defense and preservation of common goods such as the natural and human environments, which cannot be safeguarded simply by market forces”

  • 1.25 Slides: Justice - what is it? giving what’s due

    • Slide 9: Healthcare is a basic right, society has the responsibility to fulfill that right

• Two values in societal self-defense for the common good

  • the public good and individual liberty

    • societal self-defense for the common good → liberty and common good (freedom and public good)

    • freedom and relational responsibility

    • liberty is not absolute, you cannot exercise your freedom if it threatens or violates the freedom of others to not be sick or injured

• Four summary principles of Jacobson vs Massachusetts

  • (1) There must be a public health necessity

  • (2) There must be a reasonable relationship btw. intervention and its objective

  • (3) The intervention may not be arbitrary or oppressive

  • (4) The intervention should not pose a risk to its subject

• Precautionary principle

  • the precautionary principle is “beyond a reasonable doubt”

  • knowing risk outweighs uncertainty of unknown risk

    • especially when approval standards are met → probability of harm | severity of harm

  • examples: vaccines

• Formal and material cooperation with evil

  • formal: foresee and intend

    • to what degree can I be connected to doing something wrong - intentionality foresees

    • never permissible

  • material: foresee but not intend

    • to what degree can I be connected to vaccines that use embryonic cells - foresees but does not intend

    • proximate (close to evil) and remote (far from evil)

    • permissible for “proportionate reasons” such as values

    • dignity and rights (specific to CST values)

    • lack of alternatives (vaccines weren’t developed by embryonic cells practice this in the Creighton vaccine study)

• Three steps for assessing the ethics of potential public health interventions

  • 1) Analyze the ethical issues - objectively identify WHAT they are

    • public health problems, needs, concerns

    • appropriate public health goals in this context

    • source and scope of legal authority

    • relevant norms and claims of stakeholders in the situation and how strong or weighty they are

    • relevant precedent legal and ethical case

    • relevant features of the social-cultural-historical context

  • 2) Assess the Ethical Dimensions of the Public Health Options

    • Utility, Justice, Respect for liberty, and Respect for legitimate public institutions

  • 3) Provide Justification for One Particular Public Health Action

    • Effectiveness, Necessity, Least infringement, Proportianiltiy, Impartiality, and Public Justification

• Four social determinates of health

  • social, behavioral, environmental, biological

• Five aspects of the framework for social determinates of health

  • economic stability, education, social and community context, health and health care, and neighborhood and built environment

• Four Principles to “Assess the Ethical Dimensions of Public Health Options”: utility, justice, respect for liberty, respect for legitimate public institutions

  • Utility: does a particular public health option produce a balance of benefits over harms?

  • justice: are the benefits and burdens distributed fairly (distributive justice), and do legitimate representatives of affected groups have the opportunity to participate in making decisions (procedural justice)?

  • respect for liberty: does the public health action respect individual choices and interests (autonomy, liberty, and privacy)?

  • respect for legitimate public institutions: does the public health action respect professional and civic roles and values, such as transparency, honesty, trustworthiness, promise-keeping, protect confidentiality, and protecting vulnerable individuals and communities from undue stigmatization?

• Climate change

  • Climate feedbacks

    • positive feedback loop: warming accelerates warming

  • Documented post-industrial temperature rise

    • average global temperature has risen 1.1 C since 1880

  • Tipping point of post-industrial temperature rise

    • tipping point: warming accelerates, is largely irreversible, 1.5 C

  • IPCC identified emission cuts by 2025, 2030, and 2050

  • 50% chance to stay below 1.5 degrees C… on track for 2.9 degrees C by 2100

    • (1) Global Greenhouse Gas (GHS) emissions peak by 2025 (2) cut ~50% from 2019 levels by 2030 (3) net zero Co2 by ~2030 → 90% direct reduction

Essay Prompts

• Cathleen Kaveny offers two analogies of Law

  • Law as Police Officer

    • “the law should generally be restricted to prohibiting actions that wrongfully harm other persons”

      • prohibit harm to other

    • negative restraint | freedom from

    • the public health implication here is that the state DOES NOT have a duty to positively and proactively “assure the conditions under which people can be healthy”

    • minimal state intervention - YES to protect, NO to prevent, NO to promote

  • Law as Moral Teacher

    • “the proper effective law is to lead its subjects to their proper virtue: and since virtue is that which makes its subject good, it follows that the proper effective law is to make those to whom it is given, good”

      • the law needs to see the good in others

    • freedom for

      • justice as “giving what’s due” - positive and negative rights and duties

      • autonomy as freedom for flourishing enabled by freedom from undue burdens

      • solidarity as “a firm and preserving determination to commit oneself to the common good; that is to say to the good of all and of each individual because we are all responsible for all”

    • public health implications: the state does have a duty to positively and proactively “assure the conditions under which people can be healthy”

    • YES to protect, YES to prevent, YES to promote

  • the predominate guide for public health is the law as a moral teacher

    • public health: what we do as a society to ensure conditions in which people can be healthy

      • involves subsidiarity and placing that into action

      • goals of PH: (1) Protect, (2) Prevent, (3) Promote

      • law as a Moral Teacher achieves the goals of public health, as to protect, prevent, and promote

• Jacobsen vs Massachusetts

  • “societal self-defense for the common good” theory

    • the state has an ethical right and responsibility to provide social defense on behalf of its citizens against life-threatening diseases, and that the common good may legitimately override personal liberties if they are severe enough

  • two competing values

    • the following excerpt from the Jacobson court opinion illustrates the way reasons grounded in important public values, are offered and examined in a court case to justify the use of public health authority and the way the court balances two strong, competing values: the public good and individual liberty

  • Bernheim et al’s four summary principles

    • the public health intervention must be a necessity - public health provisions were necessary, given the threat of the smallpox epidemic

    • there must be a reasonable relationship between the intervention and the objective - vaccination was a reasonable means to protect the public given the circumstances

    • the intervention must NOT be arbitrary or oppressive

    • the intervention should not pose a health risk to its subject - the measure did not cause undue harm to the individual

  • theory and summary principles informed Creighton’s COVID-19 vaccine

    • the state has an ethical right and responsibility to provide social defense on behalf of its citizens against life-threatening diseases, and that the common good may legitimately override personal liberties if they are severe enough - in this case, the Judge didn’t think students would prevail in court due to signing a form promising to get vaccinated once regulators fully approved one

    • public health intervention must be a necessity - public health provisions were necessary, given the fact that the spike in COVID-19 cases was due to students coming back from different home states after breaks

    • there must be a reasonable relationship between the intervention and the objective - vaccination was a reasonable means to protect Creighton students, faculty, and staff from spreading COVID-19 if positive

    • the intervention must NOT be arbitrary or oppressive

    • the intervention should not pose a health risk to its subject - the measure did not cause undue harm to any individuals due to the agreement to get vaccinated once regulators approved

• Climate change

  • concept of greenhouse effect, climate feedbacks, tipping points, and IPCC-identified cuts by 2025, 2030, and 2050

    • Greenhouse effect - climate change is when greenhouse gases are absorbed and readmitted to the heart of space

    • Climate feedbacks - positive feedback loops state that warming accelerates warming

    • Tipping Point - warming accelerates, is largely irreversible; 1.5 degrees Celcius

    • IPCC-identified cuts - >50% chance to stay below 1.5 C:

      • (1) global GHG emissions peak by 2025 (2) cut ~50% from 2019 levels by 2030 (3) net zero CO2 by ~2050 (90% direct reduction)

  • CDC’s impact of “Impact of Climate Change on Human Health“

    • describe three categories of “health outcomes” due to human-caused climate change

      • 

        • three categories of “health outcomes” such as malnutrition, forced migration, and fatalities result from human-caused climate change

        • Due to increasing CO2 levels from humans, the effects of environmental degradation cause forced migration, civil conflict, and mental health impacts.

        • Sea levels rising and the increasing CO2 levels impact water and food supply forcing farmers in third-world countries that depend on the land to suffer the consequences.

        • Rising temperatures result in severe weather such as snow storms, tornados, and hurricanes which lead to injuries, fatalities, and mental health impacts.

  • Why do I disagree or agree?

    • I agree with the statement, “The greatest threat to global public health is the continued failure of world leaders to keep the global temperature rise below 1.5 C.”

    • Public health is “what we, as a society, do collectively to assure the conditions in which people can be healthy..”

    • this is not only said for traditional government action to protect the public but also for cooperative behavior and relationships of trust in communities

    • Collectively, world leaders fail to recognize the impact of human-caused climate change. Rather, they recognize it as the fault of the government which does not have the power to intervene in decarbonization pathways. Greenhouse gases generated via profit-motivated emissions are impacting the climate as a whole. If organizations that are profit-motivated could change their way of emissions, the goal of keeping the global temperature rise below 1.5 C before 2050 is possible.