Byskov, Morten Fibieger (2017). 'Foundational Issues and Health & Disability joint thematic panel: Public health and individual capabilities' Paper presented at the annual conference of the HDCA, Cape Town 2017.


This panel explores the theme of how measures to promote public health relate, both negatively and positively, to the capabilities of individual agents. Public health measures are policies or initiatives that are implemented with the aim to improve public health. Measures can, for example, include the promotion of healthy habits, such as healthy nutritional choices or good hygiene, or the restriction of bad habits, such as smoking or drinking. In this way, public health measures have the potential to affect the capabilities of individuals agents. Given the capability approach’s commitment to individual agency and autonomous choice (Crocker and Robeyns 2010), this raises the question of how and to what extent intrusive public health measures can be justified and/or how such conflicts can be avoided.

While the capability approach has been used to conceptualize public health (Law and Widdows 2008; Venkatapuram 2009; Ruger 2010; Nielsen 2014), little literature exists on how public health measures affect the lives and well-being of individual agents. The contributions to this panel will fill this lacuna by exploring related questions from the perspective of the capability approach, such as: How do public health measures affect the capabilities of individuals, both positively and negatively? How can the capability perspective help conceptualize the impact of public health measures? To what extent can the capability perspective help overcome conflicts between the commitment to public health and the commitment to individual freedom? How can public health measures be justified?

In his presentation, Morten Fibieger Byskov critically investigates the concept of the least restrictive means and argues that we should adopt a qualitative interpretation. Within healthcare ethics and public health ethics, it has been the custom that medical interventions should follow what is referred to as the principle of the least restrictive means (Childress et al. 2002; Nuffield Council on Bioethics 2007). In general, the principle of the least restrictive means holds that public health measures should interfere with the autonomous freedom of individuals to the least possible or necessary extent. Byskov argues that we can interpret the principle of the least restrictive means in three ways and argues that we should adopt the latter. The first two interpretations are what we could quantitative in that they measure how much, or the extent to which, an intervention interferes with the freedom of individuals while the latter interpretation is qualitative. Based on the multi-dimensional framework of the capability approach, the qualitative interpretation holds that the least restrictive means should be measured in terms of whether it restricts certain normatively valuable freedoms. Byskov further shows how the qualitative interpretation is superior in three regards to either of the quantitative interpretations.

Efrat Ram-Tiktin’s contribution seeks to shift the focus of the discussion from public health to population health. She suggests that we ought to view population health as a common good (a good that can be freely used by all) and therefore under self-interested and unregulated use it would face the danger of the tragedy of the commons. Her account of Sufficiency of Basic Human Functional Capabilities (Ram-Tiktin 2012, 2016), which provides an ethical framework for the distribution of health care, offers a possible ethical guideline for the formulation of public health measures. It will be argued that since a just social policy has to guarantee a sufficient scope of positive freedom to members of society, it is justified to limit some aspects of individuals' freedom and in other cases to manipulate or use methods that have a subtle effect on individuals' set of options.

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