What is health? What is Care?

HSCI 319W – Fall 2025 Applied Health Ethics

Lecture Details

  • Date: October 30th, 2025

  • Lecturer: Jean-Christophe Bélisle-Pipon, PhD

  • Position: Assistant Professor in Health Ethics

  • Institution: Faculty of Health Sciences, Simon Fraser University

Lecture Objectives

  • Framing Health and Care as Ethical Concepts

    • Moral Constructs: Understanding health and care not just as biomedical terms but as moral constructs.

    • Definitions and Rights: Identifying how definitions shape rights, duties, and justice claims.

    • Impact on Policy: Recognizing that ethical policies depend significantly on how health and care are defined.

    • Final Paper Connections: Linking the discussions to final paper cases including AI ethics, environmental ethics, and end-of-life ethics.

Values Behind Definitions

  • Reflection of Values: Analyzing how our definitions of health and care reveal what and whom we value within society.

  • Moral Implications: Every definition carries an implied moral goal, agent, and community.

  • Boundaries of Ethics: Ethical considerations begin where definitions may exclude certain groups or concerns.

Defining Health and Care

  • Neutral vs. Normative Definitions:

    • Non-neutral Act of Definition: Defining health or care is not a neutral process; it establishes moral boundaries.

    • Three Ethical Layers:

    • Epistemic: Who has the authority to define health and care?

    • Moral: What duties and ethical responsibilities arise from these definitions?

    • Political: How does power flow between various stakeholders involved in health and care?

  • Authorization of Actions: Definitions shape actions and responsibilities associated with health and care.

Individual vs. Collective Health

  • Definitions of Health: Moving along a spectrum from purely individual to entirely collective perspectives:

    • Individual Responsibility: (Choice A) Purely individual perspective.

    • Mostly Individual: (Choice B) Slightly collective but predominantly individual responsibility.

    • Both Individual and Collective: (Choice C) Recognizing shared responsibilities.

    • Mostly Collective: (Choice D) Emphasizing societal responsibility.

    • Entirely Collective: (Choice E) Framing health as a public good.

  • Supportive Ethical Values: Discussing ethical values supporting each choice such as autonomy, justice, solidarity, and utility.

Descriptive vs. Normative Conceptions of Care

  • Descriptive Aspect:

    • Defining health based on measurable and statistical terms.

  • Normative Aspect:

    • Defining what health ought to be, incorporating moral, social, and political aspirations.

  • Ethical Questions: Who makes these decisions? Whose suffering matters? What responsibilities arise?

Historical Ethics of Health

  • Focus on Balance: Historical view connecting health to balance, moral virtue, self-discipline, order, moderation, and harmony.

  • Public Health Ethical Framework: Public health historically linked with civic virtue and community responsibility.

WHO (1946) Definition of Health

  • Definition: “Health is a state of complete physical, mental and social well-being…”

  • Ethical Vision:

    • The definition introduces elements of social justice and equality but also raises concerns about moral perfectionism.

    • Ethical Concerns: Are such standards unattainable and unethical to set?

Biomedical Model

  • Core Concept: Defines health as the absence of disease, promoting a moralized notion of what is considered normal.

  • Ethical Focus: Primarily on diagnosis, repair, and control of diseases.

  • Risks:

    • Reductionism leads to patient passivity and excludes chronic health issues.

Biopsychosocial Model (1977)

  • Definition: Health defined as the interaction among biological, psychological, and social factors.

  • Shift in Ethical Duty: Responsibilities broadened from the individual to shared systems.

  • Vulnerability: Recognizes contextual vulnerabilities related to illness.

  • Moral Responsibility: Poses the question of who is accountable for the social causes of illness.

Social Determinants and Justice

  • Concept of Health Inequities: Health inequities viewed as reflections of structural injustices rather than natural differences.

  • Impact of Social Position: Influences exposure, vulnerability, and health outcomes.

  • Ethical Duty: Emphasizing the obligation to redesign systems rather than just treating visible symptoms.

Capability Approach

  • Flourishing Definition: Proposes that health is the capability to live a life that one values.

  • Ethical Shift: Moves beyond outcome-focused ethics to emphasize opportunities for individuals.

  • Moral Goals: Institutions should create conditions that expand freedom and agency for health.

Ecological and Planetary Health Ethics

  • Interdependency: Health defined by the interdependence of humans, animals, and ecosystems.

  • Environmental Justice Reinterpretation: Sustainability framed as a moral obligation towards future generations while addressing the tension between human welfare and environmental preservation.

Environmental Burden of Healthcare Systems

  • Impact of GHG Emissions: Healthcare systems contribute approximately 5% of global GHG emissions.

  • Ethical Paradox: The systems designed to save lives paradoxically contribute to planetary harm.

  • Responsibility Distinction: Responsibility for health-related environmental impact is distributed across various stakeholders including developers and policymakers.

Digital Health and Algorithmic Ethics

  • Redefinition of Health: Digital tools shift the notion of health from episodic care to continuous surveillance.

  • Ethical Tensions Involved:

    • Autonomy versus paternalism.

    • Privacy versus prediction.

  • Authority over Health Definitions: Who decides what constitutes a healthy state in digital terms?

  • Data Identity: Health becomes significantly influenced by data governance and moral values, often hidden from public view.

Epistemic Justice in Health

  • Definition by Miranda Fricker: Epistemic injustice occurs when certain voices, particularly marginalized or Indigenous, are discredited or excluded from knowledge generation about health.

  • Ethical Imperative: The need to acknowledge and recognize diverse knowledges in health.

  • Moral Failure: Lack of epistemic justice results in a failure to represent and respect different communities.

The Ethics of Defining Health

  • Ethical Act of Definition: Defining health carries ethical implications, influencing rights, obligations, and power structures.

  • Competing Moral Visions:

    • Control (Biomedical)

    • Flourishing (Capability)

    • Sustainability (Planetary)

    • Recognition (Epistemic Justice)

  • Guiding Question: Which ethical vision should serve as a foundation for health policy?

Defining Care

  • Care Defined: Care encapsulates action, disposition, and moral stance towards vulnerability—incorporating attention and responsibility.

  • Ethics of Care: Viewed as a response to need rather than a strict rule application, centered around interdependence.

Transition from Cure to Care

  • Shift in Medicine: Acknowledging the ethical shift from curing diseases to caring for people.

  • Cure vs. Care: Cure involves technical success, while care builds moral relationships.

    • Quote: “To cure sometimes, to relieve often, to comfort always.”

  • Efficiency Question: Care ethics challenges the prevailing efficiency-driven healthcare model.

Care Ethics Framework

  • Notable Theorists:

    • Carol Gilligan (1982): Advocates for moral reasoning based in relationships rather than rules.

    • Joan Tronto (1993): Frames care as both a political and ethical framework.

  • Four Elements of Care Ethics:

    • Attentiveness

    • Responsibility

    • Competence

    • Responsiveness

  • Challenge to Ethos: Care ethics confronts the abstractions and universalism in traditional ethics.

Care Labor and Justice

  • Undervalued Labor: Care work is often feminized, racialized, and rendered invisible within society.

  • Moral Inequality: Those who perform care work are frequently rewarded less than those who benefit from it.

  • Recognition of Care Labor: Acknowledging care work as both a moral obligation and a political platform.

Moral Labor and Burnout

  • Finite Resources: Compassion and empathy can be depleted resources.

  • Burnout: Defined as ethical exhaustion resulting from overwhelming demands rather than just psychological stress.

  • Institutional Responsibility: Questions arise about how care systems should distribute moral responsibility amongst members.

Justice vs. Care Ethics

  • Key Intersections:

    • Justice Ethics: Characterized by impartiality, rule-based approaches, and equality.

    • Care Ethics: Centers on context, relationships, and responsibilities.

  • Integrating Both Approaches: This combination leads to greater ethical maturity within health practices.

Exploring Technological Implications of Care

  • Technological Mediation: How technology changes perceptions and delivery of care.

  • Increased Tension: Examines the ethical dilemmas posed by automated systems, questioning whether machines can genuinely care.

Autonomy versus Dependence in Care

  • Western Values: Prioritize autonomy, independence, and control.

  • Reframing Dependence: Care ethics views dependence as a moral truth rather than a flaw.

  • Relational Autonomy Concept: Promotes autonomy that exists through interdependence rather than in isolation, especially relevant in contexts of disability and aging.

Global Care Chains and Economic Justice

  • Globalization Phenomenon: Care labor migration from poorer to wealthier nations illustrates inequity.

  • Ethical Dilemma: One individual’s care can create an absence elsewhere, leading to moral costs of comfort.

Compiling Ethical Perspectives on Care Systems

  • Key Care Ethics Essentials:

    • Acknowledgment of recognition, reciprocity, and responsibility in healthcare systems.

  • Balancing Act: Just health systems require a balance between justice-oriented structures and relational care practices.

  • Nature of Compassion: Compassion is finite and necessitates institutional support for sustainability.

Conclusion and Reflection Points

  • Understanding Relationships: Health without relational care leads to dehumanization, reducing patients to mere data points.

  • Impact of Care Without Health: Providing emotional support without institutional backing results in moral overload and burnout for caregivers.

  • Relational Justice Framework: Relational justice considers fairness grounded in relationships rather than abstract principles, combining distributive fairness with respect and recognition.

  • Moral Repair Concepts: Addressing injustices rooted in epistemic harm necessitates restoration of trust through ethical listening and acknowledgment.

  • Final Reflections: Continuously ask what ethically responsible health and care systems look like and how they operate within established constraints.

Take-Home Points

  • Redefining Concepts: Health as a moral vision and care as an ethical practice rooted in relationships help avenue justifiable action and accountability within health systems.

  • Institutional Design Considerations: Definitions of health and care significantly impact institutional frameworks—considering efficiency alongside empathy is vital for ethical maturity in health practice.

  • Calls for Ethical Futures: Consider ethical obligations towards societal health, and advocate for shared definitions incorporating input from diverse stakeholders, including communities.