Polonez BIS: Indywidualne uzasadnienie i niepewność w etyce zdrowia publicznego - Interdyscyplinarne Centrum Etyki (INCET)

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Indywidualne uzasadnienie i niepewność w etyce zdrowia publicznego

Indywidualne uzasadnienie i niepewność w etyce zdrowia publicznego

Projekt badawczy "Indywidualne uzasadnienie i niepewność w etyce zdrowia publicznego" współfinansowany przez Komisję Europejską i Narodowe Centrum Nauki w ramach grantu Marie Skłodowska-Curie COFUND w ramach konkursu POLONEZ BIS 3.

Podstawowe informacje

  • Tytuł projektu: Indywidualne uzasadnienie i niepewność w etyce zdrowia publicznego
  • Czas trwania: 1 września 2023 - 31 sierpnia 2025
  • Kierownik projektu: dr Jay Zameska (jay.zameska@uj.edu.pl)
  • Opiekun naukowy: dr hab. Tomasz Żuradzki, prof. UJ

Opis popularyzatorski

Public health ethics is a relatively nascent field with many significant unresolved questions. One of the most important is how we should approach ethical questions involving risk and uncertainty. Public health genomics, screening programs, mass vaccination, and many other public health activities are all often understood in terms of risk management. Historically, consequentialist frameworks have been the most popular way to resolve ethical questions involving risk and uncertainty. However, such frameworks also have some significant shortcomings, particularly related to concerns over interpersonal aggregation. In response to such concerns, there has been a resurgence in interest in alternative approaches. Within the philosophical literature, T.M. Scanlon’s contractualism has become increasingly popular as a way to address questions of risk and uncertainty. The centerpiece of this contractualist approach is the process of individual justification, which aims to find answers to ethical questions that no individual could reasonably reject. Such a process has a strong philosophical and ethical pedigree, but it is also supported by empirical research on what motivates individual compliance with public health programs. As such, this focus on justifying public health policies to people as separate and distinct individuals represents an attractive alternative approach to ethical decision making in this area.

However, there are still fundamental questions about how this process functions in conditions of risk and uncertainty. These unresolved questions stand in the way of developing contractualism as a successful non-consequentialist framework for public health ethics. In this project, I aim to answer a couple of these fundamental questions about this process of individual justification. Specifically, I aim (1) to assess the relationship between individual justification and interpretations of risk, uncertainty, and probability, with a particular focus on what this means for the status and role of individual justification in public health ethics; and (2) to analyze the impact of heuristics and biases on individual justification, and the ethical consequences of such heuristics and biases, again with a particular focus on what this means for the status and role of individual justification in public health ethics.

Tentatively, I aim to argue that the most appropriate conception of probability in this context is epistemic, meaning that probabilities describe our beliefs about the likelihood of outcomes. To do so, I intend to argue that the “individualist restriction”—a distinctive component of contractualism that forbids the aggregation of reasons during individual justification—conflicts with the standard ‘frequentist’ interpretation of probability used in epidemiology. However, an epistemic interpretation of probability can successfully bridge the gap between epidemiological evidence and contractualist decision-making in public health ethics. As such, it represents an attractive option for developing a distinctively non-consequentialist approach to ethical decision making under risk and uncertainty. Following this, I also plan to argue that such a focus on epistemic approaches requires particular and substantial attention to the role of heuristics and biases in individual justification. Relying on an epistemic conception of probability when thinking about risk in contractalist terms means that any heuristics and biases that often affect decision making under risk (e.g. anchoring bias, availability bias, affect heuristic, etc.) are particularly relevant to the process of individual justification. I aim to assess whether and to what extent such heuristics and biases may undermine the process of individual justification, and whether the process needs to be revised in light of the extensive contemporary research on such heuristics and biases.

Answering these questions allows for a moral framework that maintains the contractualist commitment to treating individuals as separate and distinct loci of moral concern, while also allowing contractualism to offer plausible and attractive answers to ethical questions involving risk and uncertainty. The overall upshot of this project is to remove some significant barriers blocking the development of an effective non-consequentialist alternative to ethical decisionmaking under conditions of risk and uncertainty in public health.

"Why we should not “help bad choosers:” screening, nudging, and epistemic risk" w czasopiśmie Medicine, Health Care and Philosophy

One prominent line of support for nudging in screening programs is the claim that nudging can help ‘bad choosers’ — that is, it can help some patients make choices more in line with their own values and preferences. In this article, I argue that due to the presence of epistemic risk in many screening programs, the argument that nudging can help ‘bad choosers’ should be revised or rejected. Expanding on the work of Biddle, J. B. 2020. Epistemic risks in cancer screening: Implications for ethics and policy. Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences 79: 101200.), I argue that epistemic risk undermines the argument that nudging can help to promote patient autonomy in the context of screening. Specifically, I argue that epistemic risk results in the inclusion of non-patient values and preferences in the screening process, which challenges the claim that nudging can help patients make choices more in line with their own values and preferences. I present four reasons to think epistemic risk undermines the argument in this way: (1) conflicting values; (2) lack of transparency; (3) limited autonomy in opting out; (4) unjustified manipulation. The presence of epistemic risk in screening programs means that nudging may not always be an effective means of promoting patient autonomy and informed consent. As such, epistemic risk poses significant challenges to at least one ethical justification of nudging in screening programs, and raises further questions about the role of nudging in promoting patient decision-making.

Zameska, J. (2024). Why we should not “help bad choosers:” screening, nudging, and epistemic risk. Medicine, Health Care and Philosophy. https://doi.org/10.1007/s11019-024-10217-8

"Issues in Bioethics and Philosophy of Medicine"

Nordic-Baltic Network of Philosophy of Medicine Annual Workshop. Reykjavik, Iceland, 2024.

"Who’s afraid of better health? A moderate defense of appeals to emotion in public health communication"

The 36 th Conference of the European Society for Philosophy of Medicine and Health Care. Frankfurt-Offenbach, Germany, 2024.

"Why Specifying Causal Pathways Featuring Social Determinants of Health Matters for Public Health Ethics"

Philosophy of Public Health. České Budějovice, Czech Republic, 2024.

Źródło finansowania

Badania zrealizowane jako część projektu nr 2022/47/P/HS1/02511 w ramach programu POLONEZ BIS współfinansowanego ze środków Narodowego Centrum Nauki oraz programu ramowego Unii Europejskiej w zakresie badań naukowych i innowacji Horyzont 2020 na podstawie umowy nr 945339 w ramach działań „Marie Skłodowska-Curie”.

Akronim: IJU-PHE 

Okładka czasopisma Medicine, Health Care and Philosophy

Nowy artykuł Jaya Zameski

Jay Zameska, pracownik INCET opublikował nowy artykuł: "Why we should not “help bad choosers:” screening, nudging, and epistemic risk" w czasopiśmie Medicine, Health Care and Philosophy
więcej o Nowy artykuł Jaya Zameski