All organisms live in close association with microbes. However, not all such associations are meaningful in an evolutionary context. Current debate concerns whether hosts and microbes are best described as communities of individuals or as holobionts (selective units of hosts plus their microbes). Recent reports that assortative mating of hosts by diet can be mediated by commensal gut microbes have attracted interest as a potential route to host reproductive isolation (RI). Here, the authors discuss logical problems with this line (...) of argument. The authors briefly review how microbes can affect host mating preferences and evaluate recent findings from fruitflies. Endosymbionts can potentially influence host RI given stable and recurrent co‐association of hosts and microbes over evolutionary time. However, observations of co‐occurrence of microbes and hosts are ripe for misinterpretation and such associations will rarely represent a meaningful holobiont. A framework in which hosts and their microbes are independent evolutionary units provides the only satisfactory explanation for the observed range of effects and associations. (shrink)

BackgroundUse of modified texture diets—thickening of liquids and modifying the texture of foods—in the hope of preventing aspiration, pneumonia and choking, has become central to the current management of dysphagia. The effectiveness of this intervention has been questioned. We examine requirements for a valid informed consent process for this approach and whether the need for informed consent for this treatment is always understood or applied by practitioners.Main textValid informed consent requires provision of accurate and balanced information, and that agreement is (...) given freely by someone who knows they have a choice. Current evidence, including surveys of practitioners and patients in different settings, suggests that practice in this area is often inadequate. This may be due to patients’ communication difficulties but also poor communication—and no real attempt to obtain consent—by practitioners before people are ‘put on’ modified texture diets. Even where discussion occurs, recommendations may be influenced by professional misconceptions about the efficacy of this treatment, which in turn may poison the well for the informed consent process. Patients cannot make appropriate decisions for themselves if the information provided is flawed and unbalanced. The voluntariness of patients’ decisions is also questionable if they are told ‘you must’, when ‘you might consider’ is more appropriate. Where the decision-making capacity of patients is in question, inappropriate judgements and recommendations may be made by substitute decision makers and courts unless based on accurate information.ConclusionResearch is required to examine the informed consent processes in different settings, but there is ample reason to suggest that current practice in this area is suboptimal. Staff need to reflect on their current practice regarding use of modified texture diets with an awareness of the current evidence and through the ‘lens’ of informed consent. Education is required for staff to clarify the importance of, and requirements for, valid informed consent and for decision making that reflects people’s preferences and values. (shrink)

Even in a society of meat-eaters such as the United States, when diet is addressed in school at all, it is widely treated as matter of personal choice, the consequences of which are borne by individual consumers. Overlooked are myriad connections involved in human diet and the implications of consumption for other entities. In the first part of this essay, Suzanne Rice discusses ways in which diet, particularly meat-eating, is connected to animal suffering, environmental harms including (...) climate change and pollution, and risks to the health of agricultural workers and consumers. In the second part, she discusses ways in which education might be “ecologized” in efforts to help students gain insight into such connections. There are many ways to ecologize education, but regardless of how teachers proceed, they are likely to encounter not only simple ignorance, relatively unproblematic gaps in students' knowledge linked to youth and inexperience, but also willful ignorance, more problematic gaps linked to avoidance, manipulation, or rejection of evidence perceived as threatening. (shrink)

In recent years, and in the current climate crisis, the interest in veganism and sustainable diet/lifestyle has increased. This growing interest can also be seen within academia. Therefore, we set out to systematically document and organize the social psychological literature on veganism and vegan identity to identify where the field currently is, and what we need to do next. Following PRISMA guidelines we identified a data set of 26 academic papers published between 2010 and 2021. Through a thematic analysis (...) of the data, we created four categories of study focus and content: vegans as a disadvantaged/stigmatized group, the role of ideology in negative attitudes toward vegans, the role of moral and ethical beliefs in changing or sustaining dietary preferences, and veganism as a social movement and vegan activism. Our analysis emphasizes issues with merging all non-meat eaters, reduction of veganism into dietary or lifestyle choices neglecting the politicized content and movement, lack of processes underlying emergence and endurance of veganism, and decontextualization of vegan identity. What is needed is a more fine-grained exploration that addresses the identified issues to account for the content of vegan identity. This would expand, for example, the motives literature to include and emphasize intersectionality in a vegan identity context. Specifically, to facilitate a more sustainable lifestyle, the content of social dimensions needs to be qualitatively explored. (shrink)

Feminist scholars have long demonstrated how women are constrained through dieting discourse. Today’s scholars wrestle with similar themes, but confront a thornier question: how do we make sense of a food discourse that frames food choices through a lens of empowerment and health, rather than vanity and restriction? This article addresses this question, drawing from interviews and focus groups with women (N = 100), as well as health-focused food writing. These data allow us to document a postfeminist food discourse that (...) we term the do-diet. The do-diet reframes dietary restrictions as positive choices, while maintaining an emphasis on body discipline, expert knowledge, and self-control. Our analysis demonstrates how the do-diet remediates a tension at the heart of neoliberal consumer culture: namely, the tension between embodying discipline through dietary control and expressing freedom through consumer choice. With respect to theory, our analysis demonstrates how the embodied dimensions of neoliberalism find gendered expression through postfeminism. We conclude that the do-diet heightens the challenge of developing feminist critiques of gendered body ideals and corporeal surveillance, as it promises a way of eating that is both morally responsible and personally empowering. (shrink)

With this text I would like to suggest the idea that vegetarianism, understood as a “principle choice” based on rational arguments and ethical norms, is supportive of and in line with the philosophy that it usually intends to contend, that is, the individualistic and anthropocentric subjectivism that is typical of the most striking tradition of Western metaphysics. Since I do not believe in the goodness and effectiveness of this model and tradition, I intend to point out that classic, rigid (...) vegetarianism is an ontological mistake that would be best avoided, precisely in order to promote a different type of thinking that is more inclusive, open, dynamic, and enlightened. I propose to name this strategy gustatory wisdom, based on a diet of caring and attention rather than on principles and rigid norms. (shrink)

To better understand the purchasing decision-making process of humane pork, and examine the internal relationship between consumers’ preferences in rational consumption and irrational decoy scenarios, 405 consumers in Wuxi City, Jiangsu Province, and China were surveyed. Attributes were set for breeding time, breeding mode, diet cleanliness label, and price, and the first three among them reflect animal welfare conditions. The results show that in the rational consumption scenarios, consumers pay the most attention to the price attribute, followed by the (...) attribute of diet cleanliness label, breeding mode, and breeding time. In the irrational decoy scenarios, consumers are most likely to be affected by the attribute decoy of diet cleanliness label, which have the utility of avoiding food safety risks. In addition, the decoy effect triggered by the price attribute which owned the highest degree of rational preference among consumers is also substantially higher, but lower than that of the diet cleanliness label attribute. The decoy effect caused by the breeding time attribute with the lowest degree of consumers’ rational preference is also the lowest. Therefore, the government should strengthen the publicity of the humane treatment of pigs before slaughter, and improve the certification and management system of pigs’ diet cleanliness. Besides, marketers are suggested to emphasis the product attributes that customer’s value the most in their advertising. (shrink)

Paul B. Thompson’s From the Field to Fork: Food Ethics for Everyone explains the growing number of ways that food connects to ethical questions concerning our consumption, production, storage, and distribution of food. Although this book serves as an introduction to food ethics for non-experts, professionals in agricultural science and food production, food activists, and philosophers will have a lot to learn from Thompson’s insight, careful argumentation, and mastery of the economic, scientific, and political issues that ground our current debates (...) about food. In my comments, I will first briefly provide an overview of Thompson’s thoughtful book. I will explain the methodology employed in this book and how his methodology applies to specific philosophical questions within food ethics. I will focus my commentary on how Thompson frames the ethics of diet and obesity. I will then raise a few questions concerning food choice and paternalism that were omitted from this book, but that I think raise substantial ethical concerns in affluent countries. I will close with a very brief comment on Thompson’s methodology. (shrink)

By focusing on the caloric composition of hunted prey species, optimal foraging research has shown that hunters usually make economically rational prey choice decisions. However, research by meat scientists suggests that the gustatory appeal of wildlife meats may vary dramatically. In this study, behavioral research indicates that Mayangna and Miskito hunters in Nicaragua inconsistently pursue multiple prey types in the optimal diet set. We use cognitive methods, including unconstrained pile sorts and cultural consensus analysis, to investigate the hypothesis (...) that these partial preferences are influenced by considerations of meat flavor. Native informants exhibit high agreement on the relative appeal of different meats. Given the absence of other noteworthy differences between spider monkeys (Ateles geoffroyi) and howler monkeys (Alouatta palliata), the unappealing flavor of howler monkeys seems to be a factor in the partial preference for this species. (shrink)

Increasing rates of obesity have fueled interest in the factors underlying food choice. While epidemiological studies report that disadvantaged social groups exhibit a higher incidence of obesity, causal evidence for an effect of social contexts on food choice remains scarce. To further our knowledge, we experimentally investigated the effect of disadvantageous social context on food choice in healthy, non-dieting participants. We used three established experimental methods to generate social contexts of different valence in controlled laboratory settings: (i) (...) receiving varying amounts of money in a Dictator Game (DG; n = 40), (ii) being included or excluded in a Cyberball Game (CBG; n = 35), and (iii) performing well, average, or poorly in a response time ranking task (RTR; n = 81). Following exposure to a particular social context, participants made pairwise choices between food items that involved a conflict between perceived taste and health attributes. In line with previous research, stronger dispositional self-control, greater cognitive control of eating behavior, and lower external eating (all assessed via questionnaires) were associated with healthier food choices. As expected, being treated unfairly in the DG, being excluded in the CBG, and performing poorly in the RTR led to negative emotions. However, we did not find an effect of the induced social context on food choice in any of the experiments, even when taking into account individual differences in participants' responses to the social context. Our results suggest that-at least in controlled laboratory environments-the influence of disadvantageous social contexts on food choice is limited. (shrink)

New studies tell how human action is causing planetary degradation and how changes to our diets and financial behaviours could lead to significant benefits. But how many of us adjust our behaviour in response to such information? This book explores people’s reactions to Optimal Rational Positions: propositions that set out requirements for change.

When consumers choose to abstain from purchasing meat, they face some uncertainty about whether their decisions will have an impact on the number of animals raised and killed. Consequentialists have argued that this uncertainty should not dissuade consumers from a vegetarian diet because the “expected” impact, or average impact, will be predictable. Recently, however, critics have argued that the expected marginal impact of a consumer change is likely to be much smaller or more radically unpredictable than previously thought. This (...) objection to the consequentialist case for vegetarianism is known as the “causal inefficacy” (or “causal impotence”) objection. In this paper, we argue that the inefficacy objection fails. First, we summarize the contours of the objection and the standard “expected impact” response to it. Second, we examine and rebut two contemporary attempts (by Mark Budolfson and Ted Warfield) to defeat the expected impact reply through alleged demonstrations of the inefficacy of abstaining from meat consumption. Third, we argue that there are good reasons to believe that single individual consumers—not just consumers in aggregate—really do make a positive difference when they choose to abstain from meat consumption. Our case rests on three economic observations: (i) animal producers operate in a highly competitive environment, (ii) complex supply chains efficiently communicate some information about product demand, and (iii) consumers of plant-based meat alternatives have positive consumption spillover effects on other consumers. (shrink)

When consumers choose to abstain from purchasing meat, they face some uncertainty about whether their decisions will have an impact on the number of animals raised and killed. Consequentialists have argued that this uncertainty should not dissuade consumers from a vegetarian diet because the “expected” impact, or average impact, will be predictable. Recently, however, critics have argued that the expected marginal impact of a consumer change is likely to be much smaller or more radically unpredictable than previously thought. This (...) objection to the consequentialist case for vegetarianism is known as the “causal inefficacy” (or “causal impotence”) objection. In this paper, we argue that the inefficacy objection fails. First, we summarize the contours of the objection and the standard “expected impact” response to it. Second, we examine and rebut two contemporary attempts (by Mark Budolfson and Ted Warfield) to defeat the expected impact reply through alleged demonstrations of the inefficacy of abstaining from meat consumption. Third, we argue that there are good reasons to believe that single individual consumers—not just individual consumers taken as an aggregate—really do make a positive difference when they choose to abstain from meat consumption. Our case rests on three economic observations: (i) animal producers operate in a highly competitive environment, (ii) complex supply chains efficiently communicate some information about product demand, and (iii) consumers of plant-based meat alternatives have positive consumption spillover effects on other consumers. (shrink)

A widespread perception is that carnivores are limited by the amount of prey that can be captured rather than their nutritional quality, and thus have no need to regulate macronutrient balance. Contrary to this view, recent laboratory studies show macronutrient‐specific food selection by both invertebrate and vertebrate predators, and in some cases also associated performance benefits. The question thus arises of whether wild predators might likewise feed selectively according to the macronutrient content of prey. Here we review laboratory studies demonstrating (...) the regulation of macronutrient intake by invertebrate and vertebrate predators, and address the question of whether this is likely to also occur in the wild. We conclude that it is highly likely that wild predators select prey or selectively feed on body parts according to their macronutrient composition, a possibility that could have significant implications for ecological and foraging theory, as well as applied wildlife conservation and management. (shrink)

Inadequate diet is the leading risk factor for morbidity and mortality worldwide. However, approaches to identifying inadequate diets in clinical practice remain inconsistent, and dietary interventions frequently focus on facilitating ‘healthy choices’, with limited emphasis on structural constraints. We examine the ethical implications of introducing a routine question in the medical history about ability to access food. Not collecting data on food security means that clinicians are unable to identify people who may benefit from support on an individual level, (...) unable to consider relevant dietary risk factors for disease and disease progression and unable to monitor population trends and inequalities in dietary access in order to design effective policy interventions. We argue that the current lack of routine screening for food insecurity is inconsistent with our approach to other health behaviours, as well as with doctors’ frequent informal role as gatekeepers to the food aid system, and recent calls for governmental action on food insecurity and health inequalities from individual clinicians and professional bodies. Potential ethical barriers to asking patients about food security are addressed, including concerns about stigma, limiting autonomy, fair resource allocation, unclear professional remits and clinicians’ ability to offer effective interventions. We suggest that there is an ethical imperative for doctors to ask patients about their ability to access healthy food. Gathering this data provides a valuable first step in re-framing the social determinants of health as modifiable risks, rather than inevitable inequities. No data are available. (shrink)

[O]ffers up a delectable intellectual challenge: can we better understand the concepts of philosophers if we look at their culinary choices? Guiding us around the philosopher's banquet table with erudition, wit, and irreverence, Michel Onfray offers surprising insights on foods ranging from fillet of cod to barley soup, from sausage to wine and coffee. Tracing the edible obsessions of philosophers from Diogenes to Sartre, Onfray considers how their ideas relate to their diets. Would Diogenes have been an opponent of civilization (...) without his taste for raw octopus? Would Rousseau have been such a proponent of frugality if his daily menu had included something more than dairy products? Nietzsche was grumpy about bad cooks and the retardation of human evolution, and Sartre was repelled by shellfish because they are 'food buried in an object, and you have to pry them out'"--Back cover. (shrink)

Around the world, unhealthy diets are a leading cause of disease. Shifting population diets in a healthier direction will require downstream policy interventions. This means changing the composition of the processed food supply, particularly reducing salt, sugar and fat. Mandatory nutrient limits imposed by government are one way of achieving this. However, they have been criticized as a particularly intrusive regulatory option, interfering with both free markets and free choices. At the same time, voluntary industry reformulation has become an intervention (...) favoured by national governments, the World Health Organization and the food industry. This article uses a comparison of the two interventions—which share a common public health goal, albeit achieved through different regulatory means—as a basis to evaluate the ethical charges against mandatory nutrient limits. It makes three main findings: that both affect free dietary choice in very similar ways; that dominant public health ethics frameworks are not well equipped to compare mandatory and voluntary forms of regulation; and that food governance is inherently multisectoral, involving markets, governments and the public. Taking these findings into account, the article calls for a more nuanced ethical evaluation of food reformulation policies. (shrink)

Food prices are a daily concern in many households’ decision-making, especially when people want to have healthier diets. Employing Bayesian Mindsponge Framework (BMF) analytics on a dataset of 710 Indonesian citizens, we found that people from wealthier households are less likely to have concerns about food prices. However, the degree of health considerations in food consumption was found to moderate against the above association. In other words, people of higher income-based social classes may worry more about food prices if they (...) care more about the health impacts of their food choices. These findings provide more insights for policymakers on the psychological aspects of promoting the balance between finance and health in food consumption. (shrink)

Who gets to decide what it means to live a healthy lifestyle, and how important a healthy lifestyle is to a good life? As more governments make preventing obesity and diet-related illness a priority, it's become more important to consider the ethics and acceptability of their efforts. When it comes to laws and policies that promote healthy eating--such as special taxes on sugary drinks and the banning of food deemed unhealthy--critics argue that these policies are paternalistic, and that they (...) limit individual autonomy over food choices. In Healthy Eating Policy and Political Philosophy: A Public Reason Approach, Anne Barnhill and Matteo Bonotti show that both paternalistic justifications for healthy eating efforts and anti-paternalistic arguments against them can be grounded in perfectionist views that overly prioritize some values over others. The authors therefore propose a more inclusive, public reason approach to healthy eating policy that will be appealing to those who take pluralism and cultural diversity seriously, by providing a framework through which different kinds of values, including but not limited to autonomy and health, can be factored into the public justification for healthy eating efforts. Additionally, the book adopts a 'farm to fork' approach to the ethics of healthy eating efforts: it engages with theories and debates in political philosophy, considers the implications of different theoretical positions for healthy eating efforts, and then develops a concrete tool for assessing policies that will be of interest to both scholars and policymakers. As well as offering a novel normative analysis of healthy eating policy, the authors offer a new theoretical framework that will be applicable to a wide range of public policy scenarios. (shrink)

Philosophers from Plato and Augustine to Heidegger, Nozick, and Baudrillard have warned us of the dangers of living on too heavy a diet of illusion and make-believe. But contemporary cultural life provides broader, more attractive opportunities to do so than have existed at any other point in history. The gentle forms of self-deceit that such experiences require of us, and that so many have regarded as ethically unwholesome or psychologically self-destructive, can in fact serve as vital means to political (...) reconciliation, cultural enrichment, and even (a kind of) utopia. -/- The first half of the book provides a highly schematic definition of simulated experience and compares it with some claims about the nature of simulation made by other philosophers about what it is for one thing to be a simulation of another. The author then provides a critical survey of the views of some major authors about the value of certain specific types of simulated experience, mainly in order to point out the many puzzling inconsistencies and ambiguities that their thoughts upon the topic often exhibit. In the second half of the book, the author defends an account of the positive social value of simulated experience and compares his own position to the ideas of a number of utopian political thinkers, as well as to Plato's famous doctrine of the "noble lie." He then makes some tentative practical suggestions about how a proper appreciation of the value of simulated experience might influence public policy decisions about such matters as the justification of taxation, paternalistic "choice management," and governmental transparency. (shrink)

Breastfeeding is analogous to pregnancy as an experience, in its exclusiveness to women, and in its cost and the effects it has on equitable share of labor. Therefore, the history of formula feeding provides useful insights into the future of full ectogenesis, which could evolve into a more severe version of what formula feeding is today: simplify life for some women and provide couples with a more equitable share of work at the cost of stigma, guilt and a daily (...) class='Hi'>diet of studies purporting to show the benefits of natural pregnancy. Making pregnancy an optional route to motherhood would make women's life trajectory more similar to men's and thus put pressure on women to compete with men on the ground shaped by men's preferences. Despite being a treasured experience of many women today, bearing children could become the luxury of the few, the province of the very poor and a choice working women will pay a high price for as women who choose pregnancy become stigmatized as self-indulgent or unprofessional and penalized for it in the workplace. At the same time, scarce societal resources that could be used to support pregnant women and working mothers would instead be directed toward proving to women or even forcing them to gestate children "the right way." While not necessarily threatening on its own, when added to formula feeding, IVF, stem-cell produced ova and sex robots, full ectogenesis could diminish men's stake in women's wellbeing and even existence. (shrink)

Rieke van der Graaf, Karin Jongsma, Martine de Vries, Suzanne van de Vathorst, and Ineke Bolt have done well to voice ethical concerns over the decision of the IAB to host the next WCB in Qatar. Conferences should be more sustainable. Yet, attention to the carbon impact of conferences—and, perhaps, any country that a person might travel to for business or pleasure—are only one small part of environmentally responsible citizenship, especially for those trained in ethics and committed to health. Both (...) bioethics as a discipline and bioethicists as individuals need to interrogate their environmental choices. To this end, some ecological choices are more obvious targets of ethical scrutiny—diet and travel—while others appear sacrosanct, like reproduction and even healthcare use. This underscores the importance of making sustainable and ethical organizational choices, such as where to hold a conference, without absolving environmental accountability in other ethical calculations. Many organizations in academic and clinical medicine need to make drastic alterations in their practices and policies to effectively mitigate carbon. While the burden is not only on bioethics alone, the expectation that it should be remains. (shrink)

In a 1983 interview, Michel Foucault contrasts our contemporary interest in sexual identity with the ancient Greek preoccupation with diet, arguing that sex has replaced food as the privileged medium of self-constitution in the modern West. In the same interview, Foucault argues that modern liberation movements should return to the ancient model of ethics, of which diet was a prime example, as aesthetics or self-transformative practice. In this paper I take up Foucault's argument with respect to the Animal (...) Liberation Movement and the dietetics of ethical vegetarianism. Contra Foucault, I suggest that diet has not been replaced by sexuality in the modern West, and that food choices, along with and intertwined with sexuality, continue to function as practices of self-constitution in both disciplinary and aesthetic fashions. I then consider the implications of this argument for the Animal Liberation Movement, exploring ways in which it might (and to some degree already does) take on aesthetic rather than moral strategies in order to pursue what Foucault once described as “an ethics of acts and their pleasures which would be able to take into account the pleasure of the other.”. (shrink)

We offer a relatively simple and straightforward argument that each of us ought to be vegan. We don’t defend this position by appealing to ‘animal rights’ or the view that animals and humans are ‘moral equals’. Rather, we argue that animal agriculture causes serious harms to other animals (such as pain, suffering and death) and these harms are morally unjustified or caused for no good reason. This is true for both ‘factory farming’ and smaller, so-called ‘humane’ farms. We argue that (...) attempts to justify these harms don’t succeed, and conclude that raising and killing animals for food is wrong. -/- In the second part of our essay we explain how this argument relates to the choices of individuals to buy and consume animal products. Since most people don’t raise and kill animals themselves, the argument above doesn’t directly address individuals’ daily choices. To address this concern, we offer a plausible, general moral principle that describes when consumers should not purchase or consume a product: most simply, we should not support those who act wrongly by seriously harming others, provided we can safely and easily do so. Since, for most people, it is safe and relatively easy to not support those who do wrong by raising and killing animals so they can be eaten, we should not buy or consume animal food products. -/- After making our case that we ought to be vegan, we respond to some of the more challenging objections to our argument. We argue that these objections don’t succeed and so, given our previous argument, nearly everyone is morally obligated to eat a vegan diet. (shrink)

This paper explores how to deliberate about food choices from a Stoic perspective informed by the value of environmental sustainability. This perspective is reconstructed from both ancient and contemporary sources of Stoic philosophy. An account of what the Stoic goal of “living in agreement with Nature” would amount to in dietary practice is presented. Given ecological facts about food production, an argument is made that Stoic virtue made manifest as wisdom, justice, courage, and temperance compel Stoic practitioners to select locally (...) sourced, low resource input, plant-based foods whenever circumstances allow. (shrink)

Many anti-obesity policies face a variety of ethical objections. We consider one kind of anti-obesity policy — modifications to food assistance programs meant to improve participants' diet — and one kind of criticism of these policies, that they are inequitable. We take as our example the recent, unsuccessful effort by New York State to exclude sweetened beverages from the items eligible for purchase in New York City with Supplemental Nutrition Support Program assistance. We distinguish two equity-based ethical objections that (...) were made to the sweetened beverage exclusion, and analyze these objections in terms of the theoretical notions of distributive equality and social equality. First, the sweetened beverage exclusion is unfair or violates distributive equality because it restricts the consumer choice of SNAP participants relative to non-participants. Second, it is disrespectful or violates social equality to prohibit SNAP participants from purchasing sweetened beverages with food stamps. We conclude that neither equity-based ethical objection is decisive, and that the proposed exclusion of sugar-sweetened beverages is not a violation of either distributive or social equality. (shrink)

The first years of life mark a time of rapid development and dietary change, as children transition from an exclusive milk diet to a modified adult diet. During these early years, children's learning about food and eating plays a central role in shaping subsequent food choices, diet quality, and weight status. Parents play a powerful role in children's eating behavior, providing both genes and environment for children. For example, they influence children's developing preferences and eating behaviors by (...) making some foods available rather than others, and by acting as models of eating behavior. In addition, parents use feeding practices, which have evolved over thousands of years, to promote patterns of food intake necessary for children's growth and health. However in current eating environments, characterized by too much inexpensive palatable, energy dense food, these traditional feeding practices can promote overeating and weight gain. To meet the challenge of promoting healthy weight in children in the current eating environment, parents need guidance regarding alternatives to traditional feeding practices. (shrink)

Rebecca Brown and Julian Savulescu argue in ‘Responsibility in Healthcare Across Time and Agents’ that if responsibility should play a crucial role in healthcare, then we need a concept of responsibility that reflects that an individual’s behaviour is sometimes, if not routinely, influenced by external factors in various ways. As Brown and Savulescu convincingly show, health-related behaviour in particular is often affected by other agents and typically involves multiple decisions on different occasions. Smoking and a poor diet are but (...) two examples where these factors are salient. Since health-related behaviour is often influenced by others, and often spread out over time, a notion of responsibility that does not take these two factors into account will be inadequate. In this comment to their paper I wish to raise an issue concerning Brown and Savulescu’s characterisation of individual responsibility for health-related behaviour that involves multiple choices by the same agent over a period of time. For simple acts—smoking a cigarette or eating some junk food for example—Brown and Savulescu assume two necessary conditions for responsibility: a ‘control condition’ and a ‘epistemic condition’. These conditions are intended to capture the plausible idea that …. (shrink)

When physicians in training enter their clinical years and first begin to become involved in clinical decision making, they soon find that more than the technical data they had so carefully learned is involved. Prior to that time, of course, they were aware that more than technology was involved in practicing medicine, but here, for the first time, the reality is forcefully brought home. It may be on the medical ward, when a patient or a patient's relatives ask that no (...) further treatment be given and that the patient be allowed to die; it may be in ob/gyn, when a 4- or 5-month pregnant lady with two other children and just deserted by her husband pleads for an abortion; it may be in the outpatient setting, where patients unable to afford enough to eat cannot afford to buy antibiotics for their sick child or provide him or her with the recom mended diet. Whatever the setting, students soon find themselv. es con fronted with problems in which an answer is not given by the technical possibilities alone; indeed, students may have to face situations in which, all things considered, the use of these technical possibilities seems ill-advised. But choices need to be made. Some of us may choose to hide behind a mastery of technology. (shrink)

A compelling look at animal welfare and factory farming in the United States from Mercy For Animals, the leading international force in preventing cruelty to farmed animals and promoting compassionate food choices and policies. Nathan Runkle would have been a fifth-generation farmer in his small midwestern town. Instead, he founded our nation’s leading nonprofit organization for protecting factory farmed animals. In Mercy For Animals, Nathan brings us into the trenches of his organization’s work; from MFA’s early days in grassroots activism, (...) to dangerous and dramatic experiences doing undercover investigations, to the organization’s current large-scale efforts at making sweeping legislative change to protect factory farmed animals and encourage compassionate food choices. But this isn’t just Nathan’s story. Mercy For Animals examines how our country moved from a network of small, local farms with more than 50 percent of Americans involved in agriculture to a massive coast-to-coast industrial complex controlled by a mere 1 percent of our population—and the consequences of this drastic change on animals as well as our global and local environments. We also learn how MFA strives to protect farmed animals in behind-the-scenes negotiations with companies like Nestlé and other brand names—conglomerates whose policy changes can save countless lives and strengthen our planet. Alongside this unflinching snapshot of our current food system, readers are also offered hope and solutions—big and small—for ending mistreatment of factory farmed animals. From simple diet modifications to a clear explanation of how to contact corporations and legislators efficiently, Mercy For Animals proves that you don’t have to be a hardcore vegan or an animal-rights activist to make a powerful difference in the lives of animals. (shrink)

The puzzling case of the broken arm -- Hernias, diets, and drugs -- Why physicians cannot know what will benefit patients -- Sacrificing patient benefit to protect patient rights -- Societal interests and duties to others -- The new, limited, twenty-first-century role for physicians as patient assistants -- Abandoning modern medical concepts: doctor's "orders" and hospital "discharge" -- Medicine can't "indicate": so why do we talk that way? --"Treatments of choice" and "medical necessity": who is fooling whom? -- Abandoning (...) informed consent -- Why physicians get it wrong and the alternatives to consent: patient choice and deep value pairing -- The end of prescribing: why prescription writing is irrational -- The alternatives to prescribing -- Are fat people overweight? -- Beyond prettiness: death, disease, and being fat -- Universal but varied health insurance: only separate is equal -- Health insurance: the case for multiple lists -- Why hospice care should not be a part of ideal health care I: the history of the hospice -- Why hospice care should not be a part of ideal health care II: hospice in a postmodern era -- Randomized human experimentation: the modern dilemma -- Randomized human experimentation: a proposal for the new medicine -- Clinical practice guidelines and why they are wrong -- Outcomes research and how values sneak into finding of fact -- The consensus of medical experts and why it is wrong so often. (shrink)

Challenging the basic assumptions of a meat-eating society, Deep Vegetarianism is a spirited and compelling defense of a vegetarian lifestyle. Considering all of the major arguments both for and against vegetarianism and the habits of meat-eaters, vegetarians, and vegans alike, Michael Allen Fox addresses vegetarianism's cultural, historical, and philosophical background; details vegetarianism's impact on one's living and thinking; and relates vegetarianism to classical and recent defenses of the moral status of animals. Demonstrating how a vegetarian diet is related to (...) our awareness of the world and our ethical outlook on life, Fox looks at the different kinds of vegetarian commitments people make and their reasons for making them. In chapters that address such issues as the experiences, emotions, and grounds that are part of choosing vegetarianism, Fox discusses not only good health, animal suffering, and the environmental impacts of meat production, but such issues as the meaning of food, world hunger, religion and spirituality, and, significantly, the links share between vegetarianism and other human rights movements and ideologies, particularly feminism. In an extensive chapter that addresses arguments made by advocates of meat-eating, Fox speaks to claims of humans as natural carnivores, animals as replaceable, and vegetarians as anti-feminist. He also addresses arguments surrounding the eating habits of indigenous peoples, eating free-range animals, and carnivorous behavior among animals. The most complete examination of the vegetarian outlook to date, Deep Vegetarianism reveals the broad range of philosophical views that contribute to such a choice. It recognizes, and calls for, a conscious awareness of -- and an individual responsibility to -- the issues that exist in the moral, political, and social spheres of our existence. With its lively and controversial discussion, Deep Vegetarianism promises to appeal to anyone looking to explore the relationship between dietary choice, lifestyle, the treatment of animals and the environment, and personal ethical responsibility. It will also be particularly useful for students and teachers of moral philosophy, ethics, religion, comparative cultures, ecology, and feminism. (shrink)

This article discusses how difficult it is to be morally consistent when choosing what to eat. Applying a moral justification in a consistent manner may result in some unorthodox diets. I distinguish two ways in which we might be inconsistent in our approach to food. We might fail to apply our morals in a consistent way, or we might fail to put our morals into practice at all. I argue that the latter represents a greater failing. Given the complexity of (...) making food choices, the former is more excusable.Export citation. (shrink)

Who gets to decide what it means to live a healthy lifestyle, and how important a healthy lifestyle is to a good life? As more governments make preventing obesity and diet-related illness a priority, it has become more important to consider the ethics and acceptability of their efforts. When it comes to laws and policies that promote healthy eating—such as special taxes on sugary drinks or programs to encourage consumption of fruits and vegetables—critics argue that these policies are paternalistic, (...) and that they limit individual autonomy over food choices. In our book Healthy Eating Policy and Political Philosophy: A Public Reason Approach (Barnhill and Bonotti 2022), we argue that both paternalistic justifications for healthy eating efforts and anti-paternalistic arguments against them can be grounded in perfectionist views that overly prioritize some values over others. We therefore propose a more inclusive, public reason approach to healthy eating policy that will be appealing to those who take pluralism and cultural diversity seriously, by providing a framework through which different kinds of values, including but not limited to autonomy and health, can be factored into the public justification for healthy eating efforts. Additionally, the book adopts a ‘farm to fork’ approach to the ethics of healthy eating efforts: it engages with theories and debates in political philosophy, considers the implications of different theoretical positions for healthy eating efforts, and then develops a framework for assessing policies that can be used by researchers and policymakers. As well as offering a novel normative analysis of healthy eating policy, we also provide a theoretical framework that will be applicable beyond healthy eating policy to a wide range of public policy scenarios. We are extremely grateful to the contributors to this symposium for their thoughtful commentaries on our book. In this article, we provide a critical reflection on the issues they raise with regard to some key aspects of our analysis. (shrink)

Photo by Tingey Injury Law Firm on Unsplash ABSTRACT The coverage of healthcare costs allegedly brought about by people’s own earlier health-adverse behaviors is certainly a matter of justice. However, this raises the following questions: justice for whom? Is it right to take people’s past behaviors into account in determining their access to healthcare? If so, how do we go about taking those behaviors into account? These bioethical questions become even more complex when we consider them in the context of (...) a commitment to publicly funded, universal healthcare coverage. INTRODUCTION Healthcare coverage of lifestyle-related conditions is certainly a matter of justice. However, this raises the following justice-related question: Is it right to consider people’s past behaviors in determining their access to healthcare? If so, the methods of taking those behaviors into account must be fair and justifiable. This bioethical question becomes even more complex when we consider it in the context of a commitment to publicly funded, universal healthcare coverage. This paper takes an old, classic debate, evaluates newer approaches, and offers an argument favoring a combined approach which alters the liberal-egalitarian solution to account for social justice. ANALYSIS l. Causes of Disease If healthcare coverage were universal, irrespective of socioeconomic status and lifestyle, people would contribute to the cost of remedying the lifestyle-induced health problems of others. In the West, lifestyle-related diseases are burdensome.[1] This paper approaches this concern from a western lens that incorporates both a European tradition of “social safety nets” and an American tradition of personal freedoms. By taking such an approach, solutions to the consequences of one’s past behavior burdening others must consider an individual’s personal freedom to choose to act as he or she wishes, with the distributive social and economic equality of the many. The concept of disease caused by lifestyle and diet is proven. Many health conditions include behavioral risk factors. Multi-pack smoking increases the risk of chronic lung disease, while obesity increases the risk of type 2 diabetes. Inattention to high blood pressure, high cholesterol, and a lack of exercise leads to increased risks of coronary artery disease.[2] While poor lifestyle choices certainly influence these conditions, their causes are multifactorial, and it is difficult to say that any single string of poor choices led to their development. In a scenario where two men excessively eat fast food for 20 years, several discrete factors impact whether any of them might suffer an ischemic-embolic stroke or not. Genetics, circumstances, and activity will also contribute to outcomes. ll. Alcohol-Related End-Stage Liver Disease One paper suggests that alcohol-related end-stage liver disease (ARESLD) differs from other multifactorial disorders as alcohol alone causes the disease.[3] It justifies attributing personal responsibility to patients with ARESLD because the condition develops only after the cumulative effects of large quantities of alcohol consumed from years to decades.[4] However, the paper undermines its position by admitting that even the susceptibility to becoming an alcoholic has some degree of genetic predisposition.[5] Given the extreme scarcity of donor livers, some patients may be prioritized over others on the transplant waiting list. Since donor livers cannot be given to everyone, transplanting a liver into an alcoholic may result in death for competing candidates whose liver disease was not their fault. All else being equal, if bioethicists avoid claiming moral deficiency or judgment, those with apparently self-inflicted ARESLD will not be deprived of treatment but will have a lower priority for transplant.[6] In contrast, another position suggests that it is often difficult to define what behaviors are punishable as these are largely personal and value-laden.[7] Still, people do not support using their own resources to support the consequences of others’ poor choices, no matter how objective.[8] In democratic societies, one must take into consideration community morals and values.[9] Even if we were to punish people for their health-adverse behaviors, we could not logistically employ the vigorous and sustained efforts necessary to determine whose actions are morally weak.[10] lll. The Liberal-Egalitarian Proposal One past argument proposes a liberal-egalitarian solution to manage personal responsibility for so-called “lifestyle diseases.”[11] This Rawlsian system combines the European-style “social safety net” commitment to social and economic equality with the American liberal notion of pluralist toleration and personal freedoms. This idealized system aims to hold people responsible for their choices rather than the consequences to mitigate the downside of blaming those who might not be blameworthy. The approach avoids determining the questionable nature of luck and personal responsibility for health outcomes, fairness in the distribution of economic burden, and the intrusiveness required to practically determine who acts in a morally wrong and health-adverse way. The liberal-egalitarian model, a theory of distributive justice, has two facets: the liberal principle that people should be held accountable for their choices and the egalitarian principle that people who make the same choices should have the same outcomes.[12] This model attempts to fuse responsibility with equity by seeking to reward good behavior and tax bad behavior rather than punish the consequences of the action and navigate who deserves treatment. For instance, the hospital bedside is not the appropriate place to introduce responsibility for one’s health outcomes.[13] This appeals to the reality that, at that time, discerning the true causes of disease was not plausible and to humanity in avoiding a heartless and cruel approach. An argument in favor of the liberal-egalitarian model considers its method of implementation. This approach assumes that the healthcare system treats all individuals regardless of their choices or ability to cover costs. The liberal-egalitarian model also assumes that a certain adverse health condition is related, statistically speaking, to the consumption of a certain good and that good can be taxed. As such, it proposes to tax the consumption of that good to finance the collective burden which arises from that good’s consumption rather than require individuals to pay for their own treatment. In the example of ARESLD, the recommended solution would be taxing all alcohol. While a systematic infrastructure is not explicit, there is the implication that a per-unit tax can be imposed on alcohol so the total tax revenue would make up for the additional healthcare costs due to consumption.[14] Upholding the principle that all people who make the same choices should face the same costs, all consumers of alcohol would pay the same tax, regardless of factors such as genetic predisposition to alcoholism, lifestyle, or expected cost of treatment. Upholding the principle of individual responsibility, this model does not deny treatment to anyone, neutralizing factors outside that individual’s control by imposing the tax ex-ante. Other people are not burdened by those who consume the good. People who consume alcohol face a burden proportional to the amount consumed. This tax-based implementation is justified so long as the tax is not prohibitively high for the average consumer. Further, the model mitigates concerns over the intrusiveness of ascribing morality to health-adverse behaviors. lV. Moral and Social Arguments Against the Liberal-Egalitarian Position Arguments against the liberal-egalitarian model concerns its many assumptions. First, this model assumes that consumption of such goods is directly related to the health outcome and that these goods can be taxed.[15] Certain people genetically predisposed to alcoholism would be predisposed to consume more alcohol. The model falls short when applied to scenarios where health outcomes are not consumption-based, such as engaging in unsafe sex or abstaining from healthy lifestyle choices like exercise. Second, some might argue that the liberal-egalitarian model fails to remain neutral. Residual moral judgments tied to consumption choices introduce non-neutrality. Although taxation in free societies is determined by democratic procedures rather than by individuals in the healthcare system, moral and value-based judgments will be implicit in deciding what behaviors are taxable, such as the purchase of cigarettes. Third, the liberal-egalitarian model fails to determine whether one’s behavior is autonomous, as socio-cultural-economic factors may influence it and behavior is more a product of society, peer pressure, or income. Those also may reflect systemic inequalities. Therefore, this model, which rewards, or taxes based solely on decisions, regardless of their consequences and motivations, fails to consider that a person’s decisions may not be completely autonomous. V. Libertarian Arguments Against the Liberal-Egalitarian Model a. State Intrusiveness as Counter to the Liberal-Egalitarian Model Last, there is a libertarian worry that if the state guarantees universal healthcare coverage to all people, the state will have to become highly intrusive and investigate people’s morals.[16] At least one-third of all disease burden in North America, Europe, and the Asia-Pacific is attributable to lifestyle measures such as tobacco smoking, alcohol consumption, high cholesterol, and obesity.[17] With these various lifestyles, it is not likely to agree on what conduct to tax or condemn.[18] The fine-toothed comb required to determine whether each citizen has been engaging in these behaviors would intrude on daily life and personal freedom. Libertarians champion the argument that impractical intrusiveness would result from universal healthcare, and such a degree of intrusiveness would likely be universally unacceptable.[19] The liberal-egalitarian model mitigates the libertarian worry about state intrusiveness as it does not involve prying into one’s life and choices other than taxing goods. A liberal state should ideally be neutral to how people decide to live their lives. In all, libertarians can rest assured that the liberal-egalitarian tax-based model, through its ex-ante implementation, will require no prying state eyes. States that provide universal healthcare coverage and wish to condemn certain misconduct do not need to become overly intrusive to carry out measures to hold individuals accountable. b. Fairness Another libertarian worry regarding the guarantee of universal healthcare coverage in the context of lifestyle-driven diseases is that the public will be burdened unfairly with covering others’ ill-advised mistakes or bad luck. An ideal system to address this worry would link treatment or payment for treatment with whatever behavior caused that need.[20] The distribution of burdens should be linked to how different individuals contributed to the creation of those burdens. Applied to health policy, we should ask how the need for a certain treatment arose when determining how to distribute its cost.[21] The liberal-egalitarian model aspires to hold individuals responsible for their choices, not for the consequences of such choices. This model significantly mitigates the libertarian worry over unfair burdens for covering other people’s mistakes or social conditions, which lead to those bad outcomes, by ensuring to not burden others with any of the costs for the treatment of people who decide to engage in certain health-adverse behaviors. The aforementioned taxation-based system would only tax those who also engage in the health-adverse behavior through consumption, and that tax directly pays for the necessary collective treatment. As such, those who do not consume the good are not involved with the payment scheme, while those who do consume the good are responsible for payment in a matter proportional to the amount of the good they have consumed. Vl. Universal Coverage Taking a step back, one should consider whether these worries regarding the coverage of apparently self-inflicted health conditions in the context of universal healthcare are worthwhile issues. One perspective raises what is called the culturally imagined objection — an idea erroneously held by many that sick people, especially those who are poor and uneducated, bring these illnesses upon themselves due to poor decision-making and irresponsible risk-taking.[22] This perspective critiques the uniquely American view that, since individuals are free to choose their lifestyles, they should bear the costs of their lifestyle.[23] Taking this argument further, some (perhaps the strongly libertarian) would say that the poor health status among many individuals is the price individuals must pay for their American way of life and the liberty and freedom to live as they wish. However, people should not completely punish individuals for their health-adverse behaviors because these choices are largely pre-determined by a person’s socioeconomic influences.[24] The outcomes from these allegedly ill-advised behaviors, which largely affect poorer people, are not just poor behavior but rather a public health crisis. Perhaps the state and its people should take collective responsibility and cover the costs of treatment for those health outcomes without question, as a form of public service. Rather than worrying about accountability and taxing bad behavior or intrusiveness into personal decisions, some might argue that people need to collectively take responsibility for reducing the overarching systemic inequalities and covering the associated treatment costs as a measure of public health. Vll. Proposed Solution Given the strengths of the liberal-egalitarian model and taking into account libertarian and social justice-oriented objections, an ideal solution for the coverage of lifestyle-related health problems needs to consider the complex relationship between a person’s behaviors and their apparent health outcomes. It must consider how society as a whole passes judgment on behaviors and how to take into account that many health-adverse decisions are not truly autonomous decisions, as various genetic and socioeconomic factors influence them. An ideal solution combines the liberal-egalitarian tax-based model with the social justice concerns of universal coverage. Whatever the cost for the treatment of medical issues resulting in part or entirely from lifestyle and diet, taxes collected from spending associated with the behavior (like the purchase of alcohol, junk food, and cigarettes) ex-ante should fund 50 percent of the cost of treatment, while the universal healthcare taxation scheme should include the other 50 percent. Such a system would provide an incentive to avoid the purchases that can lead to unhealthy consumption and make healthier choices, slightly punish and discourage such purchases through taxation, yet not overly punish people whose outcomes may have more to do with socioeconomic factors and genetics. Adding public responsibility demonstrates acknowledgement that health care is in the public interest and can mitigate public health inequalities. This solution would fuse personal responsibility with the public responsibility of state-sponsored social improvement while ensuring that all people have fair access to necessary treatment, no matter their ability to pay. CONCLUSION The 50-50 system this paper proposes reflects both justice and personal responsibility in covering healthcare costs allegedly brought about by people’s own health-adverse behaviors. By allocating tax revenue from consumption that contributes or even alone causes poor health outcomes, such a system incorporates personal responsibility. By using general tax revenue for health care, such a system would meet the libertarian requirement of providing care without any moral investigation of past behaviors and the social justice consideration of providing health care to those who may have unwittingly ventured into ill-health due to systemic injustice, socioeconomics, or genetics. - [1] Cappelen, A. W. (2005). Responsibility in health care: A liberal egalitarian approach. Journal of Medical Ethics, 31(8), 476–480. https://doi.org/10.1136/jme.2004.010421 [2] Moss, A. H. (1991). Should alcoholics compete equally for liver transplantation? JAMA: The Journal of the American Medical Association, 265(10), 1295–1298. https://doi.org/10.1001/jama.1991.03460100097032 [3] Moss, p. 1295-1298. [4] Moss, p. 1296. [5] Moss, p. 1295-1298. [6] Moss, p. 1295-1298. [7] Cohen, C. IS THIS SUPPOSED TO BE COHEN AND BENJAMIN (1991). Alcoholics and liver transplantation. JAMA: The Journal of the American Medical Association, 265(10), 1299–1301. https://doi.org/10.1001/jama.1991.03460100101033 [8] Cohen, p. 1299-1301. [9] Moss, p. 1297. [10] Cohen, p. 1300. [11] Cappelen, p. 478-480. [12] Cappalen, p. 478-480. [13] Cappelen, p.479. [14] Cappelen, p. 479. [15] Cappelen, p. 479 [16] Cohen, p. 1301. [17] Cappelen, p. 478. [18] Cohen, p. 1299-1301. [19] Cohen, p. 1301. [20] Cappelen, p. 476-480. [21] Cappelen, p. 476-480. [22] Kawachi, I. (2005). Why the United States is not number one in Health. Healthy, Wealthy, and Fair, 18–33. https://doi.org/10.1093/acprof:oso/9780195170665.003.0013 [23] Kawachi, p. 18-33. [24] Kawachi, p. 18-33. (shrink)

Blaming the individual for poor dietary habits is much easier than changing the social structure. Although society frequently assumes that the individual is able to select a particular diet amongst an array of choices, this research shows that the societal structure has quite a determinative role. This research focuses on malnutrition in Mexico and the sociopolitical and economic histories that have contributed to and maintained Mexicans’ unhealthy status. The findings of this research support Weber’s and Bourdieu’s theories describing how (...) individuals’ choices are limited by the societal structure. With this framework in mind, resolutions include fortification,supplementation, and education. From exploratory questionnaires, Mexicans living in Monterrey showed great interest in education. This suggests a starting point for further inquiry and gives insight into possible methods of attacking malnutrition. However, effective policy changes require committed political support to ensure both short-term and long-term success. (shrink)

Much has been written about the ethics of eating meat. Far less has been said about the ethics of serving meat. In this paper I argue that we often shouldn’t serve meat, even if it is morally permissible for individuals to purchase and eat meat. Historically, the ethical conversation surrounding meat has been limited to individual diets, meat producers, and government actors. I argue that if we stop the conversation there, then the urgent moral problems associated with industrial animal agriculture (...) will go unsolved. Instead, we must also consider the important but overlooked role that midsized institutions play in addressing major collective problems. I focus mostly on the harms that industrial animal agriculture inflicts on humans, animals, and the environment, but the discussion bears on other global issues like climate change. Institutional choices are an underexplored avenue for driving social change—their power and influence outstrip individual actions, and they can shape behavior in modest ways that promote social goods. Here I highlight the paradigmatic case of catered events and suggest three ways that institutional actors can reduce meat consumption and shape cultural attitudes surrounding meat: large impact decisions, subtly shaping incentives, and consolidating burdens. (shrink)

This paper discusses the moral justification behind placing a tax on foods in correlation with their greenhouse gas emissions. The background is a report from 2016 by the Danish Council of Ethics promoting a national tax on the consumption of meat from ruminants as an initial step to curb the 19–29% of total anthropogenic greenhouse gas emissions stemming from the food sector. The paper describes the contribution of food production and consumption to climate change and how a change in (...) class='Hi'>diet, away from ruminant meat in particular, could lead to substantial reductions in GHG emissions from food production and consumption. We discuss whether, given the anticipated effects on humans and the nature of climate change, individual consumers have a moral responsibility to change their diet and/or whether governments are justified in restricting the individual consumer’s freedom of choice through taxation in order to effectively reduce emissions. The paper concludes that such an intervention is warranted and necessary, both from an efficiency perspective and from an ethical perspective. (shrink)

"A probing and intelligent explanation of dieting and weight obsession that points to religiosity, morality, and absolution from guilt as the primary agents motivating women's irrational quest for thinness."--Choice.

Public health advocates, government agencies, and commercial organizations increasingly use nutritional science to guide food choice and diet as a way of promoting health, preventing disease, or marketing products. We argue that in many instances such references to nutritional science can be characterized as nutritional scientism. We examine three manifestations of nutritional scientism: the simplification of complex science to increase the persuasiveness of dietary guidance, superficial and honorific references to science in order to justify cultural or ideological views (...) about food and health, and the presumption that nutrition is the primary value of food. This paper examines these forms of nutritional scientism in the context of biopolitics to address bioethical concerns related to the misuse of scientific evidence to make claims regarding the effect of diet on health. We argue that nutritional scientism has ethical implications for individual responsibility and freedom, concerning iatrogenic harm, and for well-being. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Building a FoundationRichard KeidanA guiding principle of Judaism is "tzedakah," which translates as charity but actually means righteousness, reflecting that tzedakah is an obligation, not a choice. This concept of social justice was taught to me at home, at school and at synagogue. I gave to charities and did occasional charitable work. As my parents had taught me, I taught my own children the spirit of giving, but (...) it did come from a place of obligation, not passion. I have since come to learn that there is a world of difference between just fulfilling our obligations to each other and letting them guide the kind of person we become.It is ironic how the process of becoming a doctor—a person society expects to be selfless— requires total self-absorption. Think about it. I was trained to compete with my classmates in order to be accepted to the best university, medical school, residency, and then fellowship. I spent more than one hundred hours each week in the hospital during surgical residency. If I had free time, I wanted to do what I wanted to do. I was so focused on the end result that I had little time to think of others, let alone to ponder the inequities of the world.Several events led to the awakening of my conscience. One was an opportunity to go to Ethiopia and perform a couple weeks' worth of cancer surgery through Mother Teresa's Clinic. Quite frankly, I went because it seemed like an exciting adventure. However, I was completely overwhelmed by the experience. The conditions were abominable. The stories of each of my patients were heart-wrenching. I encountered a 14-year-old boy, the same age as my son, who had a tumor 15 cm in thickness wrapped around his neck. In order to hide the tumor he wore a scarf, but this still did not prevent him from being shunned. He traveled by himself for several days on a bus to reach the clinic. He had no one to advocate on his behalf, was unable to speak the local language, had never been outside his village (let alone in a motor vehicle), and he fearlessly underwent major surgery all by himself.The inequalities in health care compared to my suburban hospital were unfathomable. I cried every night in my hotel room. There seemed to be no solution to this situation. Soon after I returned home, Ethiopia became a distant memory. The experience cut me to the bone, but for whatever reason, I did not rally. I did not see myself as part of the solution. It took an entirely different international experience to open my eyes.There is a saying, "One goes to the Himalayas to see the mountains, but returns for the culture." In 1982, on a sabbatical from my surgical training, I went to Nepal to see the Himalayas, but fell in love with the people. Living in the most basic shelters, eating the most basic diets, with no access to clean water or toilets and little access to health care or education, the people seemed happy. I was invited into their homes and lives, slept on their straw mats, ate their rice and drank their tea. Their spirit and sense of contentment drew me back over the years 15 times. Nepal became a sanctuary for me, a place that gave me time to reflect upon what is truly important, a place that provided energy and inspiration for me. Its public health and education needs were apparent to me, but again, I felt sympathy for my Nepali friends; I did not see that I could—and must—help.It took a chance meeting to change that. Two years ago, I was on an exploratory trek on the Great Himalayan Trail in the Kanchenjunga region of Nepal. Namgyal was our sirdar (head sherpa guide), short in stature, but a giant of a man. Lacking a formal education, but very bright and [End Page 84] motivated, he rose through the ranks from porter all the way to lead sherpa of Everest Expeditions. He had reached the summit of Everest ten times by the age of thirty. He led... (shrink)

Climate change compels us to rethink the ethics of our dietary choices and has become an interesting issue for ethicists concerned about diets, including animal ethicists. The defenders of veganism have found that climate change provides a new reason to support their cause because many animal-based foods have high greenhouse gas emissions. The new style of argumentation, the ‘climatic argument for veganism’, may benefit animals by persuading even those who are not concerned about animals themselves but worry about climate change. (...) The arguments about the high emissions of animal-based food, and a resulting moral obligation to abstain from eating such products, are an addition to the prior forms of argument for principled veganism grounded on the moral standing of, and concern for, nonhuman animals. In this paper, we examine whether the climatic argument for veganism is convincing. We propose a formulation for the amended version of the argument and discuss its implications and differences compared to the moral obligations of principled veganism. We also reflect upon the implications of our findings on agricultural and food ethics more generally. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Little Body Hidden WithinTara ChapmanBeing “fat” was not a choice. It was my life and it slowly happened over time. Being obese is a disease that I have struggled with my entire life. I am 36 years old, nearing 37.I might not have eaten the right foods, but I didn’t overeat. I grew up eating typical American food and continued to cook that way into my adult life. (...) I ate eggs and toast for breakfast, sandwiches, chips and a few cookies for lunch, or leftovers, and some kind of meat and potatoes or pasta for dinner, with a canned vegetable. I very seldom ate fresh vegetables, but I did like summer fruits. However, those are filled with natural sugar and are only in season for a few months out of the year. I didn’t eat out, other than having my daily Starbucks Mocha Frappuccino on the way to work five days a week. I didn’t load my plate up with food. I ate less than my brother, sister and parents who are smaller than me. I took exercise and fitness classes all through college and knew what I was supposed to do. I exercised over the years, only to quit because I never lost weight and got discouraged. I would feel [End Page 93] better physically; however, I just kept packing on the pounds, which took a toll emotionally.By November 2012, I topped the scale at 291 pounds and could barely fit into my size 22 jeans and 3xl tops. I would sweat uncontrollably because of all the extra weight I was carrying around and could barely make it up the ramp at work or a flight of stairs without huffing and puffing. Because I would sweat profusely, my wardrobe consisted of white or black shirts. I had to hide the sweat stains. I had high blood pressure and cholesterol. I was on medication for both. My insulin levels were all over the boards. I knew that when I was shaky and my levels were high, it was time to eat. I would control my type II diabetes by eating a small piece of candy, which would instantly control my shakes. I would follow the candy up with a meal. My diet and exercise habits were causing me to have terrible headaches. In my early 20’s, I was diagnosed with Polycystic Ovarian Syndrome (PCOS). Besides having ovarian cysts and unbalanced hormones, the major issue with PSOC is unexplained weight gain and not being able to lose it. My health was spinning out of control and I secretly knew it. I just didn’t know how to fix it or what to do.I had to do something and I needed help. I didn’t want to die by the time I was 40; and the path that I was on was leading me to an early grave. I could hear it in my mom’s voice every time I talked to her. She knew something was wrong; she would try to talk to me about it and tell me I was going to have a heart attack. She would tell me how worried my dad was. I wouldn’t listen. I began to sleep more and more every day after work and on weekends. I had to take naps almost daily because I was so exhausted and had no energy. I didn’t know what to do. I was depressed and felt like I was alone. Nobody in my family understood and my friends couldn’t relate to what I was going through. I was fat and they weren’t.I heard about a special clinic that focused on women’s health issues from a co–worker. Under the close watch of the clinic’s doctor and her medical staff, I began a therapeutic lifestyle change on February 27, 2013. I had no expectations because I had always been obese. I had never lost weight, so why would this be any different? This lifestyle change includes committing to a healthy diet of high protein, vitamins and supplements, balancing hormones for PCOS and exercising. However, before I could begin changing my eating habits... (shrink)

Traditional African American foods, also referred to as “soul food,” are often given a blanket label of “poor food choices.” The cultural value of these ethnic foods may be disregarded without sufficient study of their nutrient content. This study showed that of the various foods perceived as traditionally African American by the local sampled population, greens were the most often identified as such by 78% and the most frequently consumed (22%) by the subjects. 37% perceived chitterlings as a traditional food, (...) yet only 30% consumed them, and only on an occasional basis. Okra, yams, and black-eyed peas had relatively high consumptions but were not often perceived as traditional African American foods. The latter may suggests a lack of historical food facts, relating to indigenous African foods or may indicate the mainstreaming of these foods. Cowpeas or black-eyed peas, okra, sesame seeds, and watermelon seeds were originally brought to North America from Africa. The literature contains scant information on this particular topic, which leaves unanswered: (1) the current consumption of traditional foods by African Americans, (2) certain availability of these foods; and (3) the positive contributions to the diet that these foods may contribute. The author recognizes that “African American” is the most appropriate and preferred term used widely today, to refer to African descendants in North America, however “Black” and “Black American” will be used interchangeably, to reflect consistency of literature cited herein. First, this article will define traditional African American foods and relate their historical significance. Secondly, it will present data on current food consumption from a sample population of African Americans surveyed in San Diego. Lastly, this article will explore possible applications of the research itself. (shrink)

The food we choose to eat tells a good deal about who we are and how we stand in relation to nonhuman animals and nature as a whole. Though most people are concerned about the state of the world and about their own health, they tend not to reflect very much, if at all, on what results from their dietary choices, and therefore see nothing wrong in eating meat. I question this attitude. Specifically, I argue that, for the same reasons (...) we should care about pain, suffering, well-being, and death in humans, so should we care about the fate of animals we traditionally designate as sources of meat. Caring is supplemented in my argument by considerations of justice, and I contend that for reasons of caring and justice, we should be vegetarians, consistent with the aim of minimizing the harm we cause by our lifestyle choices. Finally, I examine what it means to take responsibility for our diets and challenge meat eaters to come to terms with the wrongdoing that is inherent in the livestock industry today. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:You Mean It’s Not My Fault:Learning about Lipedema, a Fat DisorderCatherine A. Seo“As a surgeon there is nothing more I can do for you. You need to lose 75 pounds before I can even consider repairing the damage done.” Implied and not directly stated, “… Because it’s your fault.” I sat listening, dumbfounded. I was at one of the top teaching hospitals in the country, face to face with (...) a respected Harvard Medical School trained surgeon who came highly recommended.I had seemingly irreversible damage that was leading to permanent immobility. I was experiencing excessive and uncontrollable swelling in my extremities. I was in unrelenting pain that prevented me from sleeping through the night.The surgeon looked down at the floor avoiding my gaze and—after never before mentioning weight as a possible contraindication to surgery during any of our interactions associated with five surgeries, in over two years, including at least 25 consultations, pre-op, post-op, or follow-up visits stated—in essence, “I can’t help you. You are too fat. It’s your fault.” Not until now, this moment, a couple of months after “the-surgery-gone-wrong-that-ended-in-terrible-complications,” I was being told that it was my fault.He then looked down at his pager that had conveniently buzzed within minutes after he delivered this news, and then walked out of the examining room leaving me to fend for myself in dealing with serious and life-changing complications. Susan1*, his Nurse Practitioner, printed out and handed me a standard listing of BMI calculations, marched me into the common hallway to weigh me, pointed out my BMI >30, reinforced the message that he would do nothing to remedy this horrific situation unless I lost 75 pounds, and then sent me on my way.I stood outside the hospital in shock. This just wasn’t happening, and it couldn’t be happening to me. I had grown to trust this surgeon, and I was struggling to comprehend what had just happened. As the shock wore off, I reengaged in several failed attempts to get help from him. He seemed to have convinced himself that the reason the surgery had gone awry was because of my excess weight, and not because, as I later learned, I had been misdiagnosed and the procedure, as it was performed, was far too aggressive. My health condition was deteriorating and it appeared as if weight was being scapegoated for the complications.If a solution was to be found, I was going to have to find it. After many months of research, I discovered that I have lipedema, an unrecognized [End Page E6] and generally misdiagnosed hereditary, genetically-based fat disorder. I had always had lipedema, which in my case seems to have been triggered at least since puberty. There are an estimated 17 million women in the USA alone who have lipedema, unrecognized or misdiagnosed.I, like most other women in America, knew that weight was a personal choice, and fat is a result of eating too much. Or was it? This ingrained and culturally accepted structure of knowledge began to disintegrate. I then asked the question, if this disease of lipedema is a fat disorder—and I had been to many, many doctors in my 63 years—why was it never identified? Why was I left to struggle in a constant battle trying to accomplish the impossible? I then learned about and named “anti-fat bias” and began to unravel the answers.About LipedemaAccording to Karen L. Herbst, Ph.D., M.D., endocrinologist and expert on fat disorders, lipedema (lipoedema in Europe) is an inherited genetic disease, affecting at least 11% of women of all sizes, from the extremely thin to the morbidly obese, resulting in localized fat that is bilateral, symmetrical and usually from the waist to just above the ankles. It can also affect the upper arms. Unlike the “normal” fat of obesity, lipedemic fat cannot be lost through diet and exercise. It is not uncommon for the comorbidity of overweight or obesity to accompany lipedema. Allen and Hines, physicians at the Mayo Clinic, first named Lipedema in 1940.Believed... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Obesity as Disease:Definition by DesperationJeremy ShermakI hated removing my shirt. Each visit to my doctor’s office, following a blood pressure and temperature check, the nurse would instruct me to take off my shirt so the doctor could examine me further. She would then leave the room. I remained perched atop the exam table, now half exposed, and a mirror on the wall would not leave me alone. In the (...) reflection, I saw my oversized breasts and “fat roll” oozing out from my pants, hiding my belt. I tried to straighten my back—breathe in, no wait, breathe out—to resculpt the appearance, but it did nothing. I hated myself. Soon, a gentle knock at the door would interrupt the loathing and I’d shake hands with my doctor.I have been obese for the majority of my life—from childhood until I turned 34, when shortly thereafter, I had gastric bypass surgery. Since that time, I have lost 155 pounds and now write this at a comfortable, healthy 180 pounds. That said, my mind remains “obese”. My thinking remains shrouded deep within the obese personality that I embodied for all of those years. I still automatically walk to the big–and–tall section of clothing stores; I don’t recognize the 34–waist pants when they come [End Page 114] out of the dryer; I’m not used to seeing my ribs; and I’m still terrified of that exam room mirror.Upon hearing the news that the American Medical Association (AMA) now classifies obesity as a disease, my initial reaction was that of relief. My recent success was due in large part to the discovery and treatment of hindering endocrinological issues. My history—like repeatedly slamming head–long into a brick wall—suggests that these medically verified roadblocks have existed for some time. Despite my efforts, I didn’t stand a chance.If anyone were a “poster child” for obesity as a disease, it would be me. The lifelong sparring with my weight had its ups and downs; I worked very hard to maintain or lose weight with mixed results. I lost 85 pounds my freshman year of college by running and fervently watching my portions. I kept that weight off for a good five years before the summer of 2003, when I started gaining weight very quickly. I gained 25 pounds in each month of June and July that year, despite maintaining my usual eating habits and running schedule. I soon lost faith. I felt as though I was up against forces that I could not control and I began to forget about losing weight. I didn’t binge, but I didn’t eat well. By 2008, my weight had reached 375 pounds—an all–time personal high.Following a bad relationship and seeking rejuvenation, I embarked on a diet that summer like I’ve never tried before. I cooked everything naturally—from regular dishes like stuffed peppers all the way to condiments like ketchup. It was a militant effort on my part. I lost 50 pounds that summer and felt that I was well on my way back to the body that once felt so comfortable. It was at that point where I hit a wall. I could not get past 321. I can still see that number staring back at me on the scale. It was frustrating. I felt I had done all I could. That’s when I visited a doctor who ran some tests that revealed problems with my hormones and metabolic systems.As it turned out, I had a tumor on my pituitary gland. This may have been the issue all along. That led to low testosterone, which had a really negative impact on my weight loss efforts. After thorough consideration, I decided to have gastric bypass surgery to “reset” my hormones and get a “boost” in my weight loss efforts. It worked.In my particular circumstance, I could view obesity as a disease because its causes, for the most part, were not a result of conscious lifestyle choices. I had no control over the pituitary tumor. However, I know that I could have done more to limit my... (shrink)

Photo by Tingey Injury Law Firm on Unsplash ABSTRACT The coverage of healthcare costs allegedly brought about by people’s own earlier health-adverse behaviors is certainly a matter of justice. However, this raises the following questions: justice for whom? Is it right to take people’s past behaviors into account in determining their access to healthcare? If so, how do we go about taking those behaviors into account? These bioethical questions become even more complex when we consider them in the context of (...) a commitment to publicly funded, universal healthcare coverage. INTRODUCTION Healthcare coverage of lifestyle-related conditions is certainly a matter of justice. However, this raises the following justice-related question: Is it right to consider people’s past behaviors in determining their access to healthcare? If so, the methods of taking those behaviors into account must be fair and justifiable. This bioethical question becomes even more complex when we consider it in the context of a commitment to publicly funded, universal healthcare coverage. This paper takes an old, classic debate, evaluates newer approaches, and offers an argument favoring a combined approach which alters the liberal-egalitarian solution to account for social justice. ANALYSIS I. Causes of Disease If healthcare coverage were universal, irrespective of socioeconomic status and lifestyle, people would contribute to the cost of remedying the lifestyle-induced health problems of others. In the West, lifestyle-related diseases are burdensome.[i] This paper approaches this concern from a western lens that incorporates both a European tradition of “social safety nets” and an American tradition of personal freedoms. By taking such an approach, solutions to the consequences of one’s past behavior burdening others must consider an individual’s personal freedom to choose to act as he or she wishes, with the distributive social and economic equality of the many. The concept of disease caused by lifestyle and diet is proven. Many health conditions include behavioral risk factors. Multi-pack smoking increases the risk of chronic lung disease, while obesity increases the risk of type 2 diabetes. Inattention to high blood pressure, high cholesterol, and a lack of exercise leads to increased risks of coronary artery disease.[ii] While poor lifestyle choices certainly influence these conditions, their causes are multifactorial, and it is difficult to say that any single string of poor choices led to their development. In a scenario where two men excessively eat fast food for 20 years, several discrete factors impact whether any of them might suffer an ischemic-embolic stroke or not. Genetics, circumstances, and activity will also contribute to outcomes. II. Alcohol-Related End-Stage Liver Disease One paper suggests that alcohol-related end-stage liver disease (ARESLD) differs from other multifactorial disorders as alcohol alone causes the disease.[iii] It justifies attributing personal responsibility to patients with ARESLD because the condition develops only after the cumulative effects of large quantities of alcohol consumed from years to decades.[iv] However, the paper undermines its position by admitting that even the susceptibility to becoming an alcoholic has some degree of genetic predisposition.[v] Given the extreme scarcity of donor livers, some patients may be prioritized over others on the transplant waiting list. Since donor livers cannot be given to everyone, transplanting a liver into an alcoholic may result in death for competing candidates whose liver disease was not their fault. All else being equal, if bioethicists avoid claiming moral deficiency or judgment, those with apparently self-inflicted ARESLD will not be deprived of treatment but will have a lower priority for transplant.[vi] In contrast, another position suggests that it is often difficult to define what behaviors are punishable as these are largely personal and value-laden.[vii] Still, people do not support using their own resources to support the consequences of others’ poor choices, no matter how objective.[viii] In democratic societies, one must take into consideration community morals and values.[ix] Even if we were to punish people for their health-adverse behaviors, we could not logistically employ the vigorous and sustained efforts necessary to determine whose actions are morally weak.[x] III. The Liberal-Egalitarian Proposal One past argument proposes a liberal-egalitarian solution to manage personal responsibility for so-called “lifestyle diseases.”[xi] This Rawlsian system combines the European-style “social safety net” commitment to social and economic equality with the American liberal notion of pluralist toleration and personal freedoms. This idealized system aims to hold people responsible for their choices rather than the consequences to mitigate the downside of blaming those who might not be blameworthy. The approach avoids determining the questionable nature of luck and personal responsibility for health outcomes, fairness in the distribution of economic burden, and the intrusiveness required to practically determine who acts in a morally wrong and health-adverse way. The liberal-egalitarian model, a theory of distributive justice, has two facets: the liberal principle that people should be held accountable for their choices and the egalitarian principle that people who make the same choices should have the same outcomes.[xii] This model attempts to fuse responsibility with equity by seeking to reward good behavior and tax bad behavior rather than punish the consequences of the action and navigate who deserves treatment. For instance, the hospital bedside is not the appropriate place to introduce responsibility for one’s health outcomes.[xiii] This appeals to the reality that, at that time, discerning the true causes of disease was not plausible and to humanity in avoiding a heartless and cruel approach. An argument in favor of the liberal-egalitarian model considers its method of implementation. This approach assumes that the healthcare system treats all individuals regardless of their choices or ability to cover costs. The liberal-egalitarian model also assumes that a certain adverse health condition is related, statistically speaking, to the consumption of a certain good and that good can be taxed. As such, it proposes to tax the consumption of that good to finance the collective burden which arises from that good’s consumption rather than require individuals to pay for their own treatment. In the example of ARESLD, the recommended solution would be taxing all alcohol. While a systematic infrastructure is not explicit, there is the implication that a per-unit tax can be imposed on alcohol so the total tax revenue would make up for the additional healthcare costs due to consumption.[xiv] Upholding the principle that all people who make the same choices should face the same costs, all consumers of alcohol would pay the same tax, regardless of factors such as genetic predisposition to alcoholism, lifestyle, or expected cost of treatment. Upholding the principle of individual responsibility, this model does not deny treatment to anyone, neutralizing factors outside that individual’s control by imposing the tax ex-ante. Other people are not burdened by those who consume the good. People who consume alcohol face a burden proportional to the amount consumed. This tax-based implementation is justified so long as the tax is not prohibitively high for the average consumer. Further, the model mitigates concerns over the intrusiveness of ascribing morality to health-adverse behaviors. IV. Moral and Social Arguments Against the Liberal-Egalitarian Position Arguments against the liberal-egalitarian model concerns its many assumptions. First, this model assumes that consumption of such goods is directly related to the health outcome and that these goods can be taxed.[xv] Certain people genetically predisposed to alcoholism would be predisposed to consume more alcohol. The model falls short when applied to scenarios where health outcomes are not consumption-based, such as engaging in unsafe sex or abstaining from healthy lifestyle choices like exercise. Second, some might argue that the liberal-egalitarian model fails to remain neutral. Residual moral judgments tied to consumption choices introduce non-neutrality. Although taxation in free societies is determined by democratic procedures rather than by individuals in the healthcare system, moral and value-based judgments will be implicit in deciding what behaviors are taxable, such as the purchase of cigarettes. Third, the liberal-egalitarian model fails to determine whether one’s behavior is autonomous, as socio-cultural-economic factors may influence it and behavior is more a product of society, peer pressure, or income. Those also may reflect systemic inequalities. Therefore, this model, which rewards, or taxes based solely on decisions, regardless of their consequences and motivations, fails to consider that a person’s decisions may not be completely autonomous. V. Libertarian Arguments Against the Liberal-Egalitarian Model a. State Intrusiveness as Counter to the Liberal-Egalitarian Model Last, there is a libertarian worry that if the state guarantees universal healthcare coverage to all people, the state will have to become highly intrusive and investigate people’s morals.[xvi] At least one-third of all disease burden in North America, Europe, and the Asia-Pacific is attributable to lifestyle measures such as tobacco smoking, alcohol consumption, high cholesterol, and obesity.[xvii] With these various lifestyles, it is not likely to agree on what conduct to tax or condemn.[xviii] The fine-toothed comb required to determine whether each citizen has been engaging in these behaviors would intrude on daily life and personal freedom. Libertarians champion the argument that impractical intrusiveness would result from universal healthcare, and such a degree of intrusiveness would likely be universally unacceptable.[xix] The liberal-egalitarian model mitigates the libertarian worry about state intrusiveness as it does not involve prying into one’s life and choices other than taxing goods. A liberal state should ideally be neutral to how people decide to live their lives. In all, libertarians can rest assured that the liberal-egalitarian tax-based model, through its ex-ante implementation, will require no prying state eyes. States that provide universal healthcare coverage and wish to condemn certain misconduct do not need to become overly intrusive to carry out measures to hold individuals accountable. b. Fairness Another libertarian worry regarding the guarantee of universal healthcare coverage in the context of lifestyle-driven diseases is that the public will be burdened unfairly with covering others’ ill-advised mistakes or bad luck. An ideal system to address this worry would link treatment or payment for treatment with whatever behavior caused that need.[xx] The distribution of burdens should be linked to how different individuals contributed to the creation of those burdens. Applied to health policy, we should ask how the need for a certain treatment arose when determining how to distribute its cost.[xxi] The liberal-egalitarian model aspires to hold individuals responsible for their choices, not for the consequences of such choices. This model significantly mitigates the libertarian worry over unfair burdens for covering other people’s mistakes or social conditions, which lead to those bad outcomes, by ensuring to not burden others with any of the costs for the treatment of people who decide to engage in certain health-adverse behaviors. The aforementioned taxation-based system would only tax those who also engage in the health-adverse behavior through consumption, and that tax directly pays for the necessary collective treatment. As such, those who do not consume the good are not involved with the payment scheme, while those who do consume the good are responsible for payment in a matter proportional to the amount of the good they have consumed. VI. Universal Coverage Taking a step back, one should consider whether these worries regarding the coverage of apparently self-inflicted health conditions in the context of universal healthcare are worthwhile issues. One perspective raises what is called the culturally imagined objection — an idea erroneously held by many that sick people, especially those who are poor and uneducated, bring these illnesses upon themselves due to poor decision-making and irresponsible risk-taking.[xxii] This perspective critiques the uniquely American view that, since individuals are free to choose their lifestyles, they should bear the costs of their lifestyle.[xxiii] Taking this argument further, some (perhaps the strongly libertarian) would say that the poor health status among many individuals is the price individuals must pay for their American way of life and the liberty and freedom to live as they wish. However, people should not completely punish individuals for their health-adverse behaviors because these choices are largely pre-determined by a person’s socioeconomic influences.[xxiv] The outcomes from these allegedly ill-advised behaviors, which largely affect poorer people, are not just poor behavior but rather a public health crisis. Perhaps the state and its people should take collective responsibility and cover the costs of treatment for those health outcomes without question, as a form of public service. Rather than worrying about accountability and taxing bad behavior or intrusiveness into personal decisions, some might argue that people need to collectively take responsibility for reducing the overarching systemic inequalities and covering the associated treatment costs as a measure of public health. VII. Proposed Solution Given the strengths of the liberal-egalitarian model and taking into account libertarian and social justice-oriented objections, an ideal solution for the coverage of lifestyle-related health problems needs to consider the complex relationship between a person’s behaviors and their apparent health outcomes. It must consider how society as a whole passes judgment on behaviors and how to take into account that many health-adverse decisions are not truly autonomous decisions, as various genetic and socioeconomic factors influence them. An ideal solution combines the liberal-egalitarian tax-based model with the social justice concerns of universal coverage. Whatever the cost for the treatment of medical issues resulting in part or entirely from lifestyle and diet, taxes collected from spending associated with the behavior (like the purchase of alcohol, junk food, and cigarettes) ex-ante should fund 50 percent of the cost of treatment, while the universal healthcare taxation scheme should include the other 50 percent. Such a system would provide an incentive to avoid the purchases that can lead to unhealthy consumption and make healthier choices, slightly punish and discourage such purchases through taxation, yet not overly punish people whose outcomes may have more to do with socioeconomic factors and genetics. Adding public responsibility demonstrates acknowledgement that health care is in the public interest and can mitigate public health inequalities. This solution would fuse personal responsibility with the public responsibility of state-sponsored social improvement while ensuring that all people have fair access to necessary treatment, no matter their ability to pay. CONCLUSION The 50-50 system this paper proposes reflects both justice and personal responsibility in covering healthcare costs allegedly brought about by people’s own health-adverse behaviors. By allocating tax revenue from consumption that contributes or even alone causes poor health outcomes, such a system incorporates personal responsibility. By using general tax revenue for health care, such a system would meet the libertarian requirement of providing care without any moral investigation of past behaviors and the social justice consideration of providing health care to those who may have unwittingly ventured into ill-health due to systemic injustice, socioeconomics, or genetics. - [i] Cappelen, A. W. (2005). Responsibility in health care: A liberal egalitarian approach. Journal of Medical Ethics, 31(8), 476–480. https://doi.org/10.1136/jme.2004.010421 [ii] Moss, A. H. (1991). Should alcoholics compete equally for liver transplantation? JAMA: The Journal of the American Medical Association, 265(10), 1295–1298. https://doi.org/10.1001/jama.1991.03460100097032 [iii] Moss, p. 1295-1298. [iv] Moss, p. 1296. [v] Moss, p. 1295-1298. [vi] Moss, p. 1295-1298. [vii] Cohen, C. IS THIS SUPPOSED TO BE COHEN AND BENJAMIN (1991). Alcoholics and liver transplantation. JAMA: The Journal of the American Medical Association, 265(10), 1299–1301. https://doi.org/10.1001/jama.1991.03460100101033 [viii] Cohen, p. 1299-1301. [ix] Moss, p. 1297. [x] Cohen, p. 1300. [xi] Cappelen, p. 478-480. [xii] Cappalen, p. 478-480. [xiii] Cappelen, p.479. [xiv] Cappelen, p. 479. [xv] Cappelen, p. 479 [xvi] Cohen, p. 1301. [xvii] Cappelen, p. 478. [xviii] Cohen, p. 1299-1301. [xix] Cohen, p. 1301. [xx] Cappelen, p. 476-480. [xxi] Cappelen, p. 476-480. [xxii] Kawachi, I. (2005). Why the United States is not number one in Health. Healthy, Wealthy, and Fair, 18–33. https://doi.org/10.1093/acprof:oso/9780195170665.003.0013 [xxiii] Kawachi, p. 18-33. [xxiv] Kawachi, p. 18-33. (shrink)

Brussen, Kerri Anne The National Health and Medical Research Council released a new set of dietary guidelines on 18 February 2013, to help ensure that Australians continue to make healthy food choices based on the best available scientific evidence. Unlike the 2003 guidelines which were based on nutrients, these guidelines are based on food and food groups. The guidelines encourage the consumption of a varied diet and physical exercise. They also encourage the limiting of energy-dense nutrient-poor food. By making (...) these food choices, we can help to reduce our risk of diet-related disease. (shrink)

Our research discusses how four main ethical challenges to veganism manifest in the context of Iceland. Veganism is becoming an increasingly popular lifestyle in many parts of the world, especially in OECD countries. Studies on the motivation for choosing a vegan lifestyle (which includes, but is not restricted to, following a vegan diet) include ethical considerations, dietary choices, personal health, taste, religious and political beliefs, or environmental concerns. Ethics plays a particularly important role, and as such, veganism has become (...) a central object of interest in recent conversations on animal rights and welfare among ethicists. Our analysis reviews four ethical challenges (i.e., the challenge of universality, demandingness, causal impotence, and the least environmental harm principle) in the literature that problematize the norms and rationale underpinning veganism and vegan discourse and discusses how each applies within the context of Icelandic society and geography. We conjecture that the particular economic, demographic, and geographic characteristics of Iceland indicate that being vegan in Iceland does not free oneself of having global social and environmental impacts on account of chosen dietary options. All diets constitute global systems that account for dependencies and opportunities, vulnerabilities, and strengths, which may challenge the assumption that veganism is a more socially and environmentally sustainable dietary option within this particular regional context. (shrink)