Infectious Disease Control and the Harm Principle
Projectomschrijving
Biedt het schadebeginsel een adequate rechtvaardigingvoor dwingende en dringende maatregelen in de openbare gezondheidszorg? Denk bij deze maatregelen aan quarantaine, isolatie of vaccinatie.
Via theoretisch onderzoek analyseren de onderzoekers de betekenis, vooronderstellingen en gevolgen van het schadebeginsel voor infectieziektebestrijding. En ze organiseren en analyseren een reeks gesprekken met betrokkenen. Bijvoorbeeld over hoe de verantwoordelijkheid van de overheid om infecties te voorkomen zich verhoudt tot die van burgers zelf.
Het onderzoek levert een analyse op van motieven voor dwingende en dringende maatregelen in de infectieziektebestrijding. En hieruit voortvloeiend materiaal en een methode voor de GGD en het onderwijs om ethische problemen in de infectieziektebestrijding systematisch te bespreken.
Producten
Auteur: Mariëtte van den Hoven André Krom
Auteur: Marcel Verweij
Auteur: André Krom
Auteur: Marcel Verweij
Auteur: M.F. Verweij A.J.M.M. Oomen A. Krom J.E. van Steenbergen
Magazine: Infectieziekten Bulletin
Auteur: A. Krom M.F. Verweij M.J.M. te Wierik J.E. van Steenbergen
Magazine: Infectieziekten Bulletin
Auteur: A. Krom B. Rump M.F. Verweij M. Bosschart F. Woonink C.J. Kessler J.E. van Steenbergen
Magazine: Infectieziekten Bulletin
Auteur: Marcel Verweij
Magazine: Cahiers Biowetenschappen en Maatschappij
Auteur: Verweij M.F. Dawson A.J.
Magazine: Public Health Ethics
Auteur: M.F. Verweij E. de Coster J. Klomp L. Isken A. Krom J.E. van Steenbergen
Magazine: Infectieziekten Bulletin
Auteur: M.F. Verweij S. van Bergen B.J. Bos A. Krom J.E. van Steenbergen
Magazine: Infectieziekten Bulletin
Auteur: M.F. Verweij R. Appels R. Riesmeijer A. Krom J.E. van Steenbergen
Magazine: Infectieziekten Bulletin
Auteur: M.F. Verweij A. Krom J.E. van Steenbergen
Magazine: Infectieziekten Bulletin
Auteur: M.F. Verweij M.-C. Trompenaars J. Donkervoort J. den Boer A. Krom C.J. Kessler J.E. van Steenbergen
Magazine: Infectieziekten Bulletin
Auteur: Rump B. Wassenberg M. Fanoy E. Krom A. van Steenbergen J. Verweij M.
Magazine: Infectieziekten Bulletin
Auteur: M.F. Verweij B. Rump A. Krom J.E. van Steenbergen
Magazine: Infectieziekten Bulletin
Auteur: A. Krom
Magazine: Bioethics
Verslagen
Eindverslag
Samenvatting van de aanvraag
The control of infectious diseases, especially contagious disease that spread from human to human, raises moral problems. If human contact is a source for infection, then preventive measures will aim at reducing or even prohibiting such contacts. These may involve warning other parties about risks of infection; imposing hygienic measures; social distancing; isolation of patients; quarantine of healthy individuals, etc. Clearly such measures affect privacy and constrain life and choices of the individuals. The Dutch Infectieziektenwet regulates some of these interventions, but the law offers little ethical guidance for decision-making in many cases, e.g. where interventions and risks might be less extreme, but still involve major intrusions into people’s lives. Interventions and policies in infectious disease control in the Netherlands especially focus on (evidence-based) risk-assessment and –management. However, policies cannot only be based on that; reduction of risks should be weighed against other values. Ethical dimensions of infectious disease control often remain implicit in deliberation in public health practice and national (CIb/LCI) guidelines and action plans. Given the moral problems one would expect infectious disease control, there is remarkably little ethical debate in the profession or in professional literature. This project has a practical and a theoretical component that are interrelated. The practical component aims to promote ethical reflection in the profession and to contribute to responsible decision-making in infectious disease control. The theoretical component also aims at the latter goal, by means of philosophical analysis of one of the main justifications for interventions in this practice, the harm principle. The practical component starts with reviewing a database with all practical problems that prompted public health professionals to consult the Netherlands Centre for Infectious Disease Control (CIb/LCI). On the basis of this exploratory database review and subsequent interviews with health professionals and infectious disease specialists, we develop a catalogue and classification of moral problems that occur in the practice of infectious disease control. A selection of cases will be used for systematic moral analysis and deliberation in an interdisciplinary setting; the results of deliberation will lead to publication and (we aim) subsequent debate in the Infectieziektenbulletin. Case discussions will also lead to practical recommendations for national CIb/LCI guidelines. The theoretical part involves exploring the meaning and justification of the main argument for interventions for infectious disease control. Ultimately, public health professionals and the government can support restrictive policies by appealing to the harm principle: it is justified to constrain people’s freedom in order to prevent that they will harm to others. However, although the harm principle potentially offers a strong justification of liberty-limiting interventions, its meaning and scope is not as clear as often assumed – certainly not in the context of infectious disease control. A paradigm case for the harm principle would be a case where persons deliberately infect others. Such cases however are far from typical for daily infectious disease control. Public health measures to control contagious diseases do not focus on active malevolent behaviour, but on more common forms of infection, e.g. where people may forget to take precautions, or otherwise act negligently and spread disease. Infectious diseases also spread (hence control is also needed) where no one is yet aware of the infection. Moreover, some persons may even know they are not infected, and still play a role in the further spread of disease, by taking precautions or preventive measures. Many policies aim to prevent spread of disease in such contexts: strict hygienic measures; isolation of cases; screening policies; routine tests, vaccination, which can all be imposed with more or less pressure. It is not obvious that the concept of harm and the scope of the harm principle are such that the principle applies in these contexts. Hence our research questions are: Which moral problems arise in practical infectious disease control, both in prevention and outbreak management? Can the harm principle be extended in such a way that interventions aiming at the reduction of risks of infection fall within its scope? What concept of harm, and normative theory could support such a principle? Under which conditions can particular policies of infectious disease control (including policies that are not fully coercive) be justified by appeal to such an extended principle? What are the implications for relevant LCI infectious disease control guidelines?