Virtue ethics in the development of a framework for public health policymaking

[摘要] ENGLISH ABSTRACT: This dissertation has two quite separate and rather different starting points. The firstcentres on the significant renaissance of virtue ethics as a moral theory that hasoccurred in the last 50 years. The second starting point is embedded in the recentdiscourse about the need for an ethical framework for public-health policymaking.(Up until now the ethical theories of deontology, manifested as either a 'principlebased'or 'human-rights' approach, and utilitarianism, have provided the theoreticalbackground to this discourse.) When these two starting points fuse, the questionarising – can character or virtue ethics contribute positively to the moral debatessurrounding many vexing public-health issues? – seeks an answer.Broadly speaking, the ethics of public-health policymaking deals with ethical issuesthat occur within the macro-environment and that arise out of relationships betweenentities other than individuals, for example, states, regions, institutions, etcetera, andthe policies in terms of which these interactions are regulated. Public health ethics'seeks to find a balance between the notions of 'common good' or 'public interest'and individual autonomy.I plan to investigate whether a virtue-based ethics, -which is concerned with a notionof human flourishing that is not primarily atomistic but intricately linked to the mutualwell being of others and to notions of what the 'good life for man' means within thecontext of a shared history and connectedness with fellow human beings,- couldcontribute positively to current 'public health ethics' discourse. I believe that anexploration of the ethical basis of public health decision-making, focusing particularlyon virtue ethics, but also examining other approaches like utilitarianism, principlebasedapproaches and the human-rights approach, will make a positive and originalcontribution to this area of philosophical discourse.Chapter one is an introduction which provides the rationale and motivation for thedissertation and briefly introduces the layout of each subsequent chapter. Chaptertwo is a concept analysis of 'public health' and justifies why I argue that the conceptof public health is contingent, and ought to be contingent on an inextricably linked,and context appropriate concept of social justice. In this chapter I clarify the scope of the concept of public health used for this dissertation. Chapter three is an in-depthliterature review of virtue ethics and similarly the next chapter is a literature review ofthe current status of public health ethics.Chapter five is entitled 'Virtue Ethics, Social Justice and Public health. My overallaim in this dissertation is to consider if virtue ethics as a moral theory can contributepositively to the practice of public health and thus by inference to an underlyingconcept of social justice. This receives in-depth consideration in this chapter. Inchapter six I explore virtue theory in relation to public health from various otherperspectives. In particular I return to MacIntyre to consider his concept of a 'practice'1which I apply specifically to the domain of public health, exploring the concepts of'extrinsic goods and 'intrinsic goods, and how they translate to the practice ofpublic health. Chapter VII is entitled 'Theory and Practice: Critical Perspectives. Inthis chapter I explore the challenges of adapting philosophical theory to actualcontext. I focus particularly on the problems of public health policy within a SouthernAfrican context.I conclude this dissertation by conceding that while virtue ethics can indeed make apositive contribution in some respects, its applicability is largely limited to publichealth problems that pertain to specific localised contexts. It has very limitedapplicability as an ethical theory or framework for trans-global public health issues,and public health issues influenced by global politics and economics.

[发布机构] Stellenbosch University