Reasoning in Public Health
Philosophy, Risk, and Cost
Government regulates to prevent injury and disease and to promote the population's health and safety. The mere fact that the government's intentions are benevolent does not necessarily mean that regulation is warranted. Public health regulation needs to be justified because it intrudes on individual interests in liberty and property. But when is a public health intervention justified? The most thoughtful approach is to seek general principles and objective criteria to assess the worth of public health interventions. Scholars and practitioners use various forms of reasoning to accomplish this difficult task — e.g., philosophical inquiry, risk assessment, and cost-effectiveness analysis. See Figure 9.
Philosophers seek general ethical principles in justifying public health regulation. For example, University of Arizona political philosopher Joel Feinberg (1987–1990) examines the types of conduct the state may appropriately proscribe. Among the “libertylimiting” principles he discusses are harm to others (the “harm principle”) and offense to others (the “offense principle”). The “liberal position” holds that the harm and offense principles exhaust the class of good reasons for legal prohibitions. Liberal thinkers exclude harm to oneself (paternalism) as a sufficient justification for legal prohibitions.
The liberal position is not universally accepted (see Kuczewski 2001). Some ethicists believe that the state is warranted in coercing