To tackle zoonotic disease threats, a One Health approach is currently commonplace and generally understood as an integrated effort of multiple disciplines to promote the health of humans, animals and the environment. To implement One Health strategies in zoonotic disease control, many countries set up early warning systems, in which human and veterinary health professionals cooperate. These systems, like the Dutch Zoonoses Structure, can be successful to detect emerging disease threats. However, these systems are (...) not well equipped to handle moral dilemmas that can arise in zoonotic disease control, like the culling of healthy animals. This research studies the role of normative presuppositions of professionals involved in zoonotic disease control policies in the Netherlands. We found that these professionals in general adhered to a holistic view of the One Health concept, however, in practice an anthropocentric approach was dominant. Public health was identified as the trumping moral value, which reveals an inherent field of tension with the core of One Health thinking. The lack of ethical expertise in control systems for zoonotic diseases can lead to misconception of ethical principles, like the precautionary principle which is frequently evoked to justify disease control measures. (shrink)

The COVID-19 pandemic has shown that zoonotic diseases are a great threat for humanity. During the course of such a pandemic, public health authorities often apply the precautionary principle to justify disease control measures. However, evoking this principle is not without ethical implications. Especially within a One Health strategy, that requires us to balance public health benefits against the health interests of animals and the environment, unrestricted use of the precautionary principle can lead to moral dilemmas. In (...) this article, we analyze the ethical dimensions of the use of the precautionary principle in zoonotic disease control and formulate criteria to protect animals and the environment against one-sided interpretations. Furthermore, we distinguish two possible conceptions of the precautionary principle. First, we notice that because of the unpredictable nature of zoonotic diseases, public health authorities in general focus on the idea of precaution as preparedness. This reactive response often leads to difficult trade-offs between human and animal health. We therefore argue that this policy should always be accompanied by a second policy, that we refer to as precaution as prevention. Although zoonotic diseases are part of our natural world, we have to acknowledge that their origin and global impact are often a consequence of our disturbed relation with animals and the environment. (shrink)

The COVID-19 pandemic has shown that zoonotic diseases are a great threat for humanity. During the course of such a pandemic, public health authorities often apply the precautionary principle to justify disease control measures. However, evoking this principle is not without ethical implications. Especially within a One Health strategy, that requires us to balance public health benefits against the health interests of animals and the environment, unrestricted use of the precautionary principle can lead to moral dilemmas. In (...) this article, we analyze the ethical dimensions of the use of the precautionary principle in zoonotic disease control and formulate criteria to protect animals and the environment against one-sided interpretations. Furthermore, we distinguish two possible conceptions of the precautionary principle. First, we notice that because of the unpredictable nature of zoonotic diseases, public health authorities in general focus on the idea of precaution as preparedness. This reactive response often leads to difficult trade-offs between human and animal health. We therefore argue that this policy should always be accompanied by a second policy, that we refer to as precaution as prevention. Although zoonotic diseases are part of our natural world, we have to acknowledge that their origin and global impact are often a consequence of our disturbed relation with animals and the environment. (shrink)

Disease in wildlife raises a number of issues that have not been widely considered in the bioethical literature. However, wildlife disease has major implications for human welfare. The majority of emerging human infectious diseases are zoonotic: that is, they occur in humans by cross-species transmission from animal hosts. Managing these diseases often involves balancing concerns with human health against animal welfare and conservation concerns. Many infectious diseases of domestic animals are shared with wild animals, although it is (...) often unclear whether the infection spills over from wild animals to domestic animals or vice versa. Culling is the standard means of managing such diseases, bringing economic considerations, animal welfare and conservation into conflict. Infectious diseases are also major threatening processes in conservation biology and their appropriate management by culling, vaccination or treatment raises substantial animal ethics issues. One particular issue of great significance in Australia is an ongoing research program to develop genetically modified pathogens to control vertebrate pests including rabbits, foxes and house mice. Release of any self-replicating GMO vertebrate pathogen gives rise to a whole series of ethical questions. We briefly review current Australian legal responses to these problems. Finally, we present two unresolved problems of general importance that are exemplified by wildlife disease. First, to what extent can or should 'bioethics' be broadened beyond direct concerns with human welfare to animal welfare and environmental welfare? Second, how should the irreducible uncertainty of ecological systems be accounted for in ethical decision making? (shrink)

Many experts have warned that environmental degradation is increasing the likelihood of future pandemics like COVID-19, as habitat loss and poaching increase close contact between wildlife and people. This fact has been framed as a reason to increase wildlife conservation efforts. We have many good reasons to step up conservation efforts, but arguments for doing so on the basis of pandemic prevention are rhetorically, ethically, and empricially flawed.

코로나 전염병에 관한 담론을 주제로 한 본 연구는 이중적 목적을 갖고 있다. 첫째 방역정책에 있어 개인의 행동에 초점을 두는 미시적 담론에서 가장 논란이 되는 “신체주권(bodily Sovereignty)”이란 개념을 전염병 현실과 관련하여 분석한다. 이 개념의 원조인 J.S. 밀의 저작에서 신체주권이 무엇을 의미하는지 파악하고, 이를 코로나 현실 상황에 적용하여 신체주권에 기반한 주장의 타당성을 검토한다. 둘째 이렇게 미시적으로 분석된 내용을 사회-정치체계의 장기적 방향을 논의하는 거시적 담론과 연결시켜 논쟁의 향방을 ‘가늠’해보려고 시도한다. 아감벤과 지젝이 서로 대척점에 선거시논쟁에서 본 연구는 미시담론적 분석이 지젝쪽의 주장에 좀 더 무게를 (...) 실어주지 않나 어림잡아 본다. 미시와 거시라는 두 수준에서 각기 분석하여 연결을 이와 같이 시도하는 것은 코로나 전염병에 관한 담론의 전반적 구도를 드러내어 이 주제에 관한 향후 논의에 담론적 개요를 제공할 수 있기를 기대하기 때문이다. (shrink)

Human and animal interests are often in conflict. In many situations, however, it is unclear how to evaluate and weigh competing human and animal interests, as the satisfaction of the interests of one group often inevitably occurs at the expense of those of the other group. Human-animal conflicts of this kind give rise to ethical questions. If animals count morally for their own sake, then we must ask in which cases the satisfaction or frustration of the interests of humans and (...) animals in conflict situations is justified or unjustified from an ethical perspective. In this article, we argue that limited aggregation accounts represent a promising means for resolving interspecies conflicts. The reason for this is that they can appropriately consider the qualitative relevance of interests, their relative importance to each other, and the number of individuals affected. For our argument, we start from the premise that animals count morally for their own sake, albeit to a lesser extent than humans. That is, we accept the view that animals may be used, for example, as a source of food or in animal research. However, as we will show, many basic interests of animals are sufficiently similar to human interests and can thus be compared to them. Hence, they ought to be aggregated in cases of conflict with human interests. We illustrate our account and its practical implications with the real-world example of a human-animal conflict during the outbreak of a zoonotic disease among farmed animals. We conclude that, in many cases, animal interests ought to be given more importance than they currently receive, which includes distributing the burdens and risks of farming practices more fairly. (shrink)

Pandemic plans recommend phases of response to an emergent infectious disease outbreak, and are primarily aimed at preventing and mitigating human-to-human transmission. These plans carry presumptive weight and are increasingly being operationalized at the national, regional and international level with the support of the World Health Organization. The conventional focus of pandemic preparedness for EIDs of zoonotic origin has been on public health and human welfare. However, this focus on human populations has resulted in strategically important disciplinary silos. (...) As the risks of zoonotic diseases have implications that reach across many domains outside traditional public health, including anthropological, environmental, and veterinary fora, a more inclusive ecological perspective is paramount for an effective response to future outbreaks. (shrink)

Background In the context of limited health care budgets in countries where Neglected Tropical Diseases are endemic, scaling up disease control interventions entails the setting of priorities. However, solutions based solely on cost-effectiveness analyses may lead to biased and insufficiently justified priorities. Objectives The objectives of this paper are to 1) demonstrate how a range of equity concerns can be used to identify feasible priority setting criteria, 2) show how these criteria can be fed into a multi-criteria decision-making (...) matrix, and 3) discuss the conditions under which this decision-making procedure should be carried out in a real-world decision-making context. Methods This paper draws on elements from theories of decision analysis and ethical theories of fair resource allocation. We explore six typical NTD interventions by employing a modified multi-criteria decision analysis model with predefined criteria, drawn from a priority setting guide under development by the WHO. To identify relevant evidence for the six chosen interventions, we searched the PubMed and Cochrane databases. Discussion Our in vitro multi-criteria decision analysis suggested that case management for visceral leishmaniasis should be given a higher priority than mass campaigns to prevent soil-transmitted helminthic infections. This seems to contradict current health care priorities and recommendations in the literature. We also consider procedural conditions that should be met in a contextualised decision-making process and we stress the limitations of this study exercise. Conclusion By exploring how several criteria relevant to the multi-facetted characteristics of NTDs can be taken into account simultaneously, we are able to suggest how improved priority settings among NTDs can be realised. (shrink)

BackgroundIn the context of limited health care budgets in countries where Neglected Tropical Diseases (NTDs) are endemic, scaling up disease control interventions entails the setting of priorities. However, solutions based solely on cost‐effectiveness analyses may lead to biased and insufficiently justified priorities.ObjectivesThe objectives of this paper are to 1) demonstrate how a range of equity concerns can be used to identify feasible priority setting criteria, 2) show how these criteria can be fed into a multi‐criteria decision‐making matrix, and (...) 3) discuss the conditions under which this decision‐making procedure should be carried out in a real‐world decision‐making context.MethodsThis paper draws on elements from theories of decision analysis and ethical theories of fair resource allocation. We explore six typical NTD interventions by employing a modified multi‐criteria decision analysis model with predefined criteria, drawn from a priority setting guide under development by the WHO. To identify relevant evidence for the six chosen interventions, we searched the PubMed and Cochrane databases.DiscussionOur in vitro multi‐criteria decision analysis suggested that case management for visceral leishmaniasis should be given a higher priority than mass campaigns to prevent soil‐transmitted helminthic infections. This seems to contradict current health care priorities and recommendations in the literature. We also consider procedural conditions that should be met in a contextualised decision‐making process and we stress the limitations of this study exercise.ConclusionBy exploring how several criteria relevant to the multi‐facetted characteristics of NTDs can be taken into account simultaneously, we are able to suggest how improved priority settings among NTDs can be realised. (shrink)

Veterinarians play an essential role in the animal-based food chain. They are professionally responsible for the health of farm animals to secure food safety and public health. In the last decades, food scandals and zoonotic disease outbreaks have shown how much animal and human health are entangled. Therefore, the concept of One Health is broadly promoted within veterinary medicine. The profession embraces this idea that the health of humans, animals and the environment is inextricably linked and supports the (...) related call for transdisciplinary collaboration. Especially in zoonotic disease control, the benefits of the cooperation between veterinarians and human doctors seem evident. However, applying a One Health approach also makes moral problems explicit. For instance, how should veterinarians deal with situations in which measures to protect public health negatively affect animal health? This creates a conflict of professional responsibilities. To deal with such moral problems and to strengthen the veterinarian’s position, the starting point is a holistic perspective on One Health. We will argue for an ‘encapsulated health’ argument: the best way to safeguard human health is to promote the health of animals and the environment. This also holds for the responsibility of the veterinary profession: to serve public health, the central responsibility of veterinarians should be to be experts in animal health and welfare. We elaborate this point by using a case study on the role of the veterinary profession in antimicrobial resistance policies in the Netherlands. (shrink)

One of most pertinent and acute risks that the world is now facing is emerging or re-emerging zoonotic diseases. This article focuses on culling as a measure for zoonotic disease control, specifically the culling of 11,000 badgers as part of the Randomized Badger Culling Trial in the UK and the culling exercises in Singapore. The independent expert panel that devised the UK study concluded that reactive culling was ineffective in reducing the cases of bovine tuberculosis in (...) cattle. The panel also concluded that proactive culling was not cost-effective. Behind the scarcity of empirical evidence to support culling, the resultant reduction in biodiversity can actually harm both animals and humans. Public health policies should be evidence-based, culturally adaptable and ethically justified; a novel biomedical and public health approach, named One Health, plausibly provides a reasonable ethical framework as well as research and interventional methods that square with that framework. OH recognizes that nonhuman animals and humans are interlinked in both sickness and health, since we all share the same ecosystem. OH could potentially replace standard public health strategies, as it provides alternative evidence-based methods for biomedical research and adds a non-anthropocentric component to an ethical decision-making process. (shrink)

This article argues that governments in countries that currently permit intensive animal agriculture - especially but not exclusively high-income countries - are, in principle, morally justified in taking steps to restrict or even eliminate intensive animal agriculture to protect public health from the risk of zoonotic pandemics. Unlike many extant arguments for restricting, curtailing, or even eliminating intensive animal agriculture which focus on environmental harms, animal welfare, or the link between animal source food (ASF) consumption and noncommunicable disease, (...) the argument in this article appeals to the value of protecting populations from future global health emergencies and their broad social, economic, and health impacts, taking the SARS-CoV-2 virus as a particularly salient example. The article begins by identifying how intensive animal agriculture contributes to the outbreak (and risk of future outbreaks) of zoonotic diseases. Next, we explore three specific policy options: 1. Incentivizing plant-based and cell-based ASF alternatives through government subsidies; 2. Disincentivizing intensive ASF production through the adoption of a “zoonotic tax”; and 3. Eliminating intensive ASF production through a total ban. We argue that all three of these measures are permissible, although we remain agnostic as to whether these measures are obligatory. We argue for this conclusion on the grounds that each measure is justified by the same sorts of considerations that justify other widely accepted public health interventions, and each is compatible with a variety of theories of justice. We then address potential objections. Finally, we discuss how our novel argument relates to extant ethical arguments in favor or curtailing ASF production and consumption. (shrink)

During the course of the COVID-19 pandemic, a wide range of digital technologies and data analytics have been incorporated into pandemic response models globally, in the hope of better detecting, tracking, monitoring and containing outbreaks. This increased digital involvement in disease control has offered the prospect of heightened effectiveness in all of the above, but not without raising other concerns. This paper contributes to ongoing discussions of the digital transformation in disease control by proposing a materialist (...) analysis of how such control has become operative and what its effects may be, both now and in the future. Using Taiwan's digital pandemic response as a case study, the paper explores specific ways in which material processes and arrangements have shaped digital measures, as well as the actions that rendered such measures operable, with their ensuing consequences. This analysis illustrates the importance of historical, material and technological specificities and contingencies to our understanding of how digital disease control takes a particular shape. It also demonstrates how shifting regimes of practice continually reconfigure the ways in which digital disease control functions. The paper argues that paying greater attention to the materialities of digital disease control can provide a more nuanced understanding of the complex ways in which society may be protected or harmed by its use, possibly simultaneously. It is hoped that such increased attentiveness may inform more considered and careful preparation for subsequent pandemics. (shrink)

A central tenet of medical ethics holds that it is permissible to perform a medical intervention on a competent individual only if that individual has given informed consent to the intervention. However, in some circumstances it is tempting to say that the moral reason to obtain informed consent prior to administering a medical intervention is outweighed. For example, if an individual’s refusal to undergo a medical intervention would lead to the transmission of a dangerous infectious disease to other members (...) of the community, one might claim that it would be morally permissible to administer the intervention even in the absence of consent. Indeed, as we shall discuss below, there are a number of examples of public health authorities implementing compulsory or coercive measures for the purposes of infectious disease control (IDC). The plausibility of the thought that non-consensual medical interventions might be justified when performed for the purpose of IDC raises the question of whether such interventions might permissibly be used to realize other public goods. In this article we focus on one possibility: whether it could be permissible to non-consensually impose certain interventions that alter brain states or processes through chemical or physical means on serious criminal offenders. We shall suggest that some such interventions might be permissible if they safely and effectively serve to facilitate the offender’s rehabilitation and thereby prevent criminal recidivism. (shrink)

Effective infectious disease control may require states to restrict the liberty of individuals. Since preventing harm to others is almost universally accepted as a legitimate (prima facie) reason for restricting the liberty of individuals, it seems plausible to employ a mid‐level harm principle in infectious disease control. Moral practices like infectious disease control support – or even require – a certain level of theory‐modesty. However, employing a mid‐level harm principle in infectious disease (...) class='Hi'>control faces at least three problems. First, it is unclear what we gain by attaining convergence on a specific formulation of the harm principle. Likely candidates for convergence, a harm principle aimed at preventing harmful conduct, supplemented by considerations of effectiveness and always choosing the least intrusive means still leave ample room for normative disagreement. Second, while mid‐level principles are sometimes put forward in response to the problem of normative theories attaching different weight to moral principles, employing a mid‐level harm principle completely leaves open how to determine what weight to attach to it in application. Third, there appears to be a trade‐off between attaining convergence and finding a formulation of the harm principle that can justify liberty‐restrictions in all situations of contagion, including interventions that are commonly allowed. These are not reasons to abandon mid‐level theorizing altogether. But there is no reason to be too theory‐modest in applied ethics. Morally justifying e.g. if a liberty‐restriction in infectious disease control is proportional to the aim of harm‐prevention, promptly requires moving beyond the mid‐level harm principle. (shrink)

Human-wildlife interactions frequently lead to conflicts – about the fair use of natural resources, for example. Various principled accounts have been proposed to resolve such interspecies conflicts. However, the existing frameworks are often inadequate to the complexities of real-life scenarios. In particular, they frequently fail because they do not adequately take account of the qualitative importance of individual interests, their relative importance, and the number of individuals affected. This article presents a limited aggregation account designed to overcome these shortcomings and (...) thus to facilitate decision-making in real-world human-wildlife conflicts. (shrink)

Social media applications such as Twitter, YouTube and Facebook have attained huge popularity, with more than three billion people and organizations predicted to have a social networking account by 2015. Social media offers a rapid avenue of communication with the public and has potential benefits for communicable disease control and surveillance. However, its application in everyday public health practice raises a number of important issues around confidentiality and autonomy. We report here a case from local level health protection (...) where the friend of an individual with meningococcal septicaemia used a social networking site to notify potential contacts. (shrink)

When in 2006 the Centers for Disease Control and Prevention issued revised recommendations for HIV testing in health care settings, vocal opponents charged that use of an ?opt-out? approach to presenting HIV testing to patients; the implementation of nontargeted, widespread HIV screening; the elimination of a separate signed consent; and the decoupling of required HIV prevention counseling from HIV testing are unethical. Here we undertake the first systematic ethical examination of the arguments both for and against the recommendations. (...) Our examination reveals that the ethical concerns raised by the critics predominately pertain not to ethically suspect elements of the recommendations themselves, but to suspicions that they will be implemented improperly. It has not been shown that the recommendations cannot be implemented properly. Here we show that in the United States the recommendations are morally justifiable and that safeguards or regulatory oversight may serve to ensure that the recommendations are properly implemented. (shrink)

In 1892, the British agricultural authorities introduced a policy of slaughtering animals infected with foot and mouth disease (FMD). This measure endured throughout the 20th century and formed a base line upon which officials superimposed the controversial "contiguous cull" policy during the devastating 2001 epidemic. Proponents of the slaughter frequently emphasized its capacity to eliminate FMD from Britain, and claimed that it was both cheaper and more effective than the alternative policies of isolation and vaccination. However, their discussions reveal (...) that a less obvious but nonetheless important reason for maintaining the slaughter policy was the conviction that in its manner of operation and its outcomes, it benefited the state and status of the British nation. To its supporters, slaughter was far more than a method of disease control; it acted also as a moralizing and civilizing force, an indicator of veterinary ability and a "virility symbol" of British international leadership. This "cultural" rationale for FMD control by slaughter declined during the late 20th century and was wholly undermined by the 2001 epidemic, when extensive culling failed to convey the intended image of an organized, enlightened Britain. (shrink)

The infection rates of COVID-19 have been exponential in some countries despite the imposition of infectious disease control measures such as lockdowns and physical distancing, which form one of the basic principles of public health and infectious disease control. There have been significant problems with leaders and citizenry deliberately ignoring and not complying with such measures and which have directly resulted in sudden rises in infection numbers. Here, I show the nature and extent of the widespread (...) problem and argue that the problem is in large part due to our modern society characterised by liberal individualism. I apply the philosophy proposed by philosopher Alasdair MacIntrye to show that one key underlying cause of the non-compliant behaviour of citizenry is due to modern liberal individualism that has deprived the modern nation state of the opportunities and authority for it to teach or to dictate what is the common good of the society as a whole to individuals in its community. This is the first time MacIntyre’s philosophy has been applied to public health, and this paper demonstrates the need for ethics education to counter-balance liberal individualism in order to contain and to prevent another pandemic and public health crisis in modern society. (shrink)

Increases in international travel and migratory flows have enabled infectious diseases to emerge and spread more rapidly than ever before. Hence, it is increasingly easy for local infectious diseases to become global infectious diseases (GIDs). National governments must be able to react quickly and effectively to GIDs, whether naturally occurring or intentionally instigated by bioterrorism. According to the World Health Organisation, global partnerships are necessary to gather the most up-to-date information and to mobilize resources to tackle GIDs when necessary. Communicable (...) disease control also depends upon national public health laws and policies. The containment of an infectious disease typically involves detection, notification, quarantine and isolation of actual or suspected cases; the protection and monitoring of those not infected; and possibly even treatment. Some measures are clearly contentious and raise conflicts between individual and societal interests. In Europe national policies against infectious diseases are very heterogeneous. Some countries have a more communitarian approach to public health ethics, in which the interests of individual and society are more closely intertwined and interdependent, while others take a more liberal approach and give priority to individual freedoms in communicable disease control. This paper provides an overview of the different policies around communicable disease control that exist across a select number of countries across Europe. It then proposes ethical arguments to be considered in the making of public health laws, mostly concerning their effectiveness for public health protection. (shrink)

Social media applications such as Facebook hold great promise as means of communicable disease control. We argue here that the use of social media in communicable disease control may cause various forms of harm, and that these harms are aggravated by some of the very same features making social media attractive in the attempt to control disease. We point to alternative measures of disease control and further argue that although disease (...) class='Hi'>control may be the primary task of health practitioners, there is no good reason why the choosing of the least invasive measures in terms of privacy and confidentiality should not also be a key priority. (shrink)

Background: In 2006, the Centers for Disease Control and Prevention (CDC) recommended three changes to HIV testing methods in US healthcare settings: (1) an opt-out approach, (2) removal of separate signed consent, and (3) optional HIV prevention counseling. These recommendations led to a public debate about their moral acceptability. Methods: We interviewed 25 members from the fields of US HIV advocacy, care, policy, and research about the ethical merits and demerits of the three changes to HIV testing methods. (...) We performed a qualitative analysis of the participant responses in the interviews and summarized the major themes. Results: In general, arguments in favor of the methods were based upon their ultimate contribution to increasing HIV testing and permitting the consequent benefits of identifying those who are HIV infected and linking them to further care. Conclusions: The prevailing theme of ethical concern focused on suspicions that the methods might not be properly implemented, and that further safeguards might be needed. (shrink)

The 2006 Centers for Disease Control and Prevention (CDC) revised recommendations for HIV testing in clinical settings contained seven specific changes to how health care facilities should provide HIV testing. These seven elements have been both supported and challenged in the lay and medical literature. Our first paper in BMC Medical Ethics presented an analysis of the three HIV testing procedural changes included in the recommendations. In this paper, we address the four remaining elements that concern HIV screening (...) policy changes: (1) nontargeted HIV screening, (2) making HIV screening similar to screening for other treatable conditions, (3) increasing HIV screening without assured additional funding for linkage to care, and (4) making patients bear the costs of increased HIV screening in health care settings. (shrink)

Livestock production has been confronted with several epidemics over the last decades. The morality of common animal disease strategies—stamping out and vaccination—is being debated and provokes controversies among farmers, authorities and the broader public. Given the complexity and controversy of choosing an appropriate control strategy, this article explores the potential of nano-enabled diagnostics in future livestock production. At first glance, these applications offer promising opportunities for better animal disease surveillance. By significantly shortening the reaction time from diagnosis (...) to appropriate control, they could complement the current disease management strategies. Although nano-enabled diagnostics will not make livestock disease eradication strategies redundant or completely free of the culling of infected animals, these diagnostics could significantly reduce the number of culled animals and animal suffering. This article aims to demonstrate that the ethical assessment of advanced diagnostics can build on the experiences with decision making in biomedical ethics where nonmaleficence, beneficence, autonomy and justice serve as important benchmarks. Nano-enabled diagnostics may be an ethically sound solution if it can resolve the dilemma between stamping out and vaccination in favor of the latter and if it can balance the autonomy–paternalism dilemma between farmers and authorities. The technology should allow to be switched on and off by farmers, whilst simultaneously allowing for a weak paternalism on behalf of authorities in order to benefit the farmer and broader society and to protect them from harm. (shrink)

Human encroachment on the habitats of wild animals and the dense living conditions of farmed animals increase spill-over risk of emerging infectious diseases from animals to humans (such as COVID-19). In this article, we defend two claims: First, we argue that in order to limit the risk of emerging infectious disease outbreaks in the future, a One Health approach is needed, which focuses on human, animal, and environmental health. Second, we claim that One Health should not solely be grounded (...) in collaborations between veterinary, medical, and environmental scientists, but should also involve more dialogue with animal and environmental ethicists. Such an interdisciplinary approach would result in epidemiology-driven measures that are ethically legitimate. (shrink)

Emerging infectious diseases such as Ebola, Hendra, SARS, West Nile, Hepatitis E and avian influenza have led to a renewed recognition of how diseases in human beings, wildlife and livestock are interlinked. The changing prevalence and spread of such infections are largely determined by human activities and changes in environment and climate—where the latter are often also caused by human activities. Since the beginning of the 21st century, these insights have been brought together under the heading of OneHealth—a concept that (...) calls for interdisciplinary collaboration between various sciences as well as professional practices to promote and protect the health of human and non-human animals and the natural environment. Just as insights from public health have led to a broadened focus for health policy and medical care, from treating individual patients to protecting and promoting population health, OneHealth calls for an even broader perspective, including a concern for the environment and animals, and for social-cultural factors that affect human, animal and environmental health. OneHealth not only covers collaborative work to understand and control zoonotic diseases, but also other ways in which interactions between animals, plants and humans may positively or negatively impact on each other’s health. Thus, studies in veterinary medicine and environmental sciences may lead to new insights in human medicine, and vice versa. Acknowledgment of the links between environmental, animal and social health is of course not a novel insight. Hippocrates already pointed to the importance of a clean environment as a requirement for good health; the early public health movements emphasized hygienic living conditions including good-quality housing, sewage systems and clean air and water; and the founders of modern medicine such as William Osler and Rudolf Virchow promoted …. (shrink)

The purpose of this article is to explore both the legal difficulties and policy objections in using public nuisance against conduct which exposes others to the risk of contracting a harmful disease. Drawing on the judicial and legislative responses in Australia, Canada, New Zealand and the United Kingdom, I will identify the important issues of legal principle and public policy which must be addressed when considering the imposition of criminal liability in these circumstances.

(No abstract is available for this citation).

One Health, as an international movement and as a research methodology, aspires to cross boundaries between disciplines. However, One Health has also been viewed as “reductionist” due to its overemphasize on physicians-veterinarians cooperation and surveillance capacity enhancement, while limiting the involvement with socio-political preconditioning factors that shape the impact of diseases, and the ethical questions that eventually structure interventions. The current article draws on a qualitative study of Brucellosis control in Israel, to address the benefits of broadening the One (...) Health perspective to include ethical considerations and the socio-political aspects of health. Using in-depth-interviews, observations and document review, the article analyzes stakeholders’ knowledge (policy makers, practitioners and livestock owners) to understand Brucellosis control interventions in the Negev region of Israel. The analysis highlights four different types of boundaries: geographical, professional, disciplinary and participatory. The variety of boundaries going beyond disciplinary ones, are often neglected by traditional One Health discourses, however they provide clearer understanding regarding the role of the Israel and Palestine relations; enforcement activities and trust creation; and mechanisms of decision-making and public participation, in Brucellosis interventions. A broad One Health analysis that addresses ethical concerns and socio-political environments, as well as human and veterinary medicine, encourages re-framing of causes and solutions when dealing particularly with Brucellosis in the Negev, but more generally with zoonotic diseases, low-trust settings and inequitable distribution of power. The inclusion of historical, political and bioethical considerations of Public Health in One Health creates opportunities to increase the relevance of One Health and expand its scope as a novel scientific paradigm. (shrink)

In this view from 2007–2009, the ethical challenges facing a potential global effort to control infectious disease are explored; they provide sobering insight into the challenges of later decades. Despite the devastating pandemic of HIV/AIDS that erupted in the early 1980s, despite the failure to eradicate polio and the emergence of resistant forms of tuberculosis that came into focus in the 1990s, and despite newly emerging diseases like Severe Acute Respiratory Syndrome (SARS) in 2003 and the fearsome prospect (...) of human-to-human avian flu, it is nevertheless a time of some excitement over prospects for effective control of much of infectious disease. Funded by national and international governmental and nongovernmental organizations (NGOs), private foundations, and even popular entertainers, large-scale new efforts are under way to address global killers like AIDS, tuberculosis, and malaria, among others. This “marvelous momentum” can be seen as part of a continuing effort from the time of Jenner onward. Extrapolating from this, we explore the notion of a “comprehensive global effort for the eradication, elimination or control of infectious disease”, with particular attention to the ethical issues that arise. This is to “think big” about disease-control efforts that are now often done in piecemeal ways. This chapter identifies five tracks along which such efforts need to be pursued: (1) national and international organizations and the development of collective will; (2) epidemiological and health care infrastructure; (3) scientific development; (4) religious, social, and cultural considerations; (5) legal and social protections for individuals and groups. Each of these poses significant ethical issues which, we argue, should be viewed in a comprehensive way, to ensure that practice, research, and policy in each of these areas understands the person with communicable infectious disease as both victim and (potential) vector. (shrink)

This book is... a survey history of medicine from the earliest times, centered thematically on how changing concepts of disease have affected its management.... One finds a gratifying mastery of recent as well as classic scholarship in medical history and a careful sidestepping of positivistic excesses.... Disease and Its Control is a fresh and welcome synthesis of historical scholarship that will be accessible to interested laymen. (Annals of Internal Medicine).

Beginning in 1989, the breakup of the Soviet Bloc disrupted trade and cut off Cuba's source of subsidized fuel oil, making many modern agricultural practices impossible, including the wide use of pesticides. Among Cuba's responses was an emphasis on biological control of plant diseases. Research into biological control began in the 1930s, and after the revolution many scientists maintained an unofficial interest. When the 1989 economic crisis occurred, the government placed a high priority on biocontrol, and researchers were (...) in a position to begin immediate implementation. For example, the construction of factories for the mass production of biological agents had been approved in 1988, and are currently in operation. Disease monitoring was undertaken before the current crisis, with more than 90% of Cuban agriculture using it to some extent. Such monitoring has allowed a reduction in pesticide use. Since the 1989 onset of economic crisis the monitor system has not been greatly modified for use with biological control techniques, but an example of a successful transition from chemical treatment to biocontrol in Cuba is in banana plantations.At the various research centers, research is being conducted in the biocontrol of vegetable diseases, tobacco root diseases, nematodes, and pasture weeds. Technical research is being done on mass production of inoculum, the production of application formulations, and storage of biocontrol products. Because wide use of biocontrol agents was urgently desired, the government cooperated at every step of research, including in regulatory matters. Obstacles to successful biocontrol mentioned by Cuban scientists were the lack of taxonomic knowledge and the need for strict quality control.There are few economic studies of biocontrol agents despite the importance of such studies. Cuban scientists are in an excellent position to do such research. Forced by the economic crisis to act, Cuba has made a major change in national agronomic policy that may represent a significant and new direction for “modern” agricultural practices. (shrink)

The scientific understanding of common chronic disease began in the mid-19th century, driven in large part by the development of the modern autopsy. For cardiovascular disease, the recognition that rigid plaques were obstructing muscular arteries, especially in the coronary arteries, provided a mechanism to explain what had been a mysterious "chest pain–sudden collapse" syndrome. The origin of these plaques was totally obscure, however, and they were given the descriptive name of "atherosclerosis," or "hardened porridge" in Greek. Not until (...) 50 years later, when animal experimental models serendipitously revealed the hyper-lipidemic consequences of a diet high in animal fat, followed by accretion of lipid... (shrink)

Online personalized genetic testing services offer accessible and convenient options for satisfying personal curiosity about health and obtaining answers about one’s genetic provenance. They are especially attractive to healthy people who wish to learn about their future risk of disease, as Paul Mason’s case study of “Jordan” illustrates. In this response, we consider how online genetic testing services are used by people diagnosed with a common neurodegenerative disease, Parkinson’s disease, to gain a sense of certainty regarding the (...) future. (shrink)

ABSTRACT Patient self‐management (SM) of chronic disease is an evolving movement, with some forms documented as yielding important outcomes. Potential benefits from proper preparation and maintenance of patient SM skills include quality care tailored to the patient's preferences and life goals, and increase in skills in problem solving, confidence and success, generalizable to other parts of the patient's life. Four central ethical issues can be identified: 1) insufficient patient/family access to preparation that will optimize their competence to SM without (...) harm to themselves, 2) lack of acknowledgement that an ethos of patient empowerment can mask transfer of responsibility beyond patient/family competency to handle that responsibility, 3) prevailing assumptions that preparation for SM cannot result in harm and that its main purpose is to deliver physician instructions, and 4) lack of standards for patient selection, which has the potential to exclude individuals who could benefit from learning to SM. Technology assessment offers one framework through which to examine available data about efficacy of patient SM and to answer the central question of what conditions must be put in place to optimize the benefits of SM while assuring that potential harms are controlled. (shrink)