20 January 2022: Research seminar - Elena Popa: Distrust and Decision Making in Public Health
We have the pleasure to invite you to another research seminar in the ‘BIOUNCERTAINTY’ research project. The seminar will take place on Thursday, 20th of January at 5:30 p.m. via MS Teams.Abstract: This paper employs philosophical analyses of distrust to argue for more just decision making in public health. While philosophical research on distrust is still an emerging topic, current analyses highlight its normative dimension (D’Cruz 2020; McLeod 2020; Hawley 2014), as well as connections to values such as justice (Krishnamurthy 2015). Krishnamurthy’s account in particular, holds that distrust amounts to ‘a confident belief that other individuals, groups, or institutions will not act as justice requires’ (2015: 397). As public health decisions are not isolated from the social contexts where they are made, comprising structural injustice and inequity, there is a risk of exacerbating these factors. A recent example is the COVID-19 pandemic, which was linked to an increase in inequality, taking a higher toll on those already in vulnerable positions (e.g. CashGibson et al. 2021; Chen & Wang 2021; Gray 2021). In such context, members of vulnerable groups are justified in distrusting public health authorities given that their interests have been constantly overlooked. Still, Krishnamurthy’s account also emphasizes that warranted distrust can help drive social change. In this case, seeing why certain groups are justified in distrusting public health authorities can help make future public health decisions more just.
Upon investigating whether it is ethical to implement policies that take a higher toll on the most vulnerable, Hansson’s (2018) framework for risk analysis is useful. Hansson makes the case for ensuring that there are no groups that only take risks, with other groups in charge of the decision making process reaping the benefits. This runs against utilitarianism in particular, which would allow certain groups to be the least well off and long as the overall welfare is maximized (Hansson 2018: 1826). I argue that in the context of public health, this version of the utilitarianism breaks down, as sustained distrust from significant parts of the population can undermine public health efforts. To use the example of COVID-19 again, low vaccine uptake due to distrust can be at least partly explained by the neglect of certain groups (e.g. having little to no access to medical services; having experienced epistemic injustice in past interactions with medical professionals; poor educational services). Thus, a consequence of distrust is low compliance with public health requirements, and in the long term the overall welfare is likely to decrease. I further argue that this requires a re-thinking of consequentialism, with focus on longer term consequences. If public health approaches that promote trust can yield better long term outcomes, they are preferable to those that do not. One important related point is that the attention to warranted distrust requires closer attention to social factors. Public health measures should be connected with other social interventions – say, providing further support for the unemployed or precarious workers. This is consistent with earlier considerations on public health needing to address inequality given the strong link between socio-economic situation and health (Kass 2001).