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(2021)Southwest Sydney mayors say new COVID - 19 restrictions segregates community from rest of Greater Sydney
(1992)Philosophical Plumbing. Royal Institute of Philosophy Supplements
M. Verweij (2007)The meaning of 'public' in 'public health'
M. Midgley (1992)Philosophical Plumbing
Royal Institute of Philosophy Supplement, 33
Stephanie Collins (2019)Group Duties
Kathryn MacKay (2023):Philosophy for Public Health and Public Policy: Beyond the Neglectful State
PUBLIC HEALTH ETHICS VOLUME 15 ISSUE 1 2022 23–26 23 • • • Case Comment Response: Collective Moral Agents and Their Collective-Level Virtues Kathryn MacKay *, Sydney Health Ethics, The University of Sydney, Australia *Corresponding author: Kathryn MacKay, Sydney Health Ethics, The University of Sydney, Rm 133, Edward Ford Building A27, Camperdown, NSW 2006, Australia. Tel.: þ61 290 363 403; Email: firstname.lastname@example.org In this short piece, I attempt to respond to some of the challenges raised by Jessica Nihl en Fahlquist and Karen Meagher in their commentaries on my paper, ‘Public Health Virtue Ethics’. While these authors have made many insightful and challenging remarks, I mostly focus on two questions here: ﬁrst, about the nature of collectives as moral agents, in response to Nihlen Fahlquist, and second, about the concept of a collective-level virtue, in response to Meagher. In the two commentaries presented in this symposium, for public health requires a full paper of its own. But, Jessica Nihl en Fahlquist and Karen Meagher present because the issue is pressing and Nihl en Fahlquist is right stimulating and challenging responses to my paper on to say so, I will make a brief response. public health virtue ethics. It is very rewarding to be in What do we mean when we assign moral agency to a dialogue on this topic. I am extremely grateful to both collective or group? We do assign moral agency to col- authors for taking the time to read and respond to my lectives and groups, with regularity, but this does not paper as carefully as they have. make the answer to this question easy to furnish My paper represents a tentative initial account of (Collins, 2019). Nihl en Fahlquist asks, is public health structures of virtue in the context of public health prac- primarily the sum of individual actions and activities tice, and Nihl en Fahlquist and Meagher have each iden- reflecting individual agency, or is it primarily a collective tified weaknesses that need attention. The concerns actor with some kind of group agency (5)? raised by Nihl en Fahlquist and Meagher show, which The answer to this partly depends on how we have questions are perhaps most pressing in developing this defined public health. The metaphysical complexity of account further. ‘public health’ has been written about previously, and it The table included in Meagher’s commentary, which is clear that there are many meaningful ways to inter- employs David Pear’s taxonomy of virtue-related goals, pret this phrase (Dawson and Verweij, 2007). The am- provides a useful way to compare the accounts of virtue biguity of the term ‘public health’ calls for a distinction in public health that I, Michael Rozier and Nihl en between (at least) acts that can be characterized as con- Fahlquist present. While my account is focussed on col- tributing to the public’s health, acts done in the name of lectives as such, Nihl en Fahlquist’s work in this area has the health of the public and acts done in the offices of an focussed on public health practitioners as individuals, agency with some special responsibilities or roles and Rozier has focussed on community members as regarding the health of the public. Though many things individuals. It is the collective focus of my account that can fall under the umbrella of ‘public health’, I was Nihl en Fahlquist most closely critiques, and I begin with limiting my discussion to public health as a branch of her concerns. government in welfarist societies. Examples of such Nihl en Fahlquist takes me to task for not addressing governmental branches include the Public Health questions around conceptualizing public health as a Agency of Canada, or Public Health England, which group moral agent in this paper. Early on, I set this issue holds a range of official roles and powers in a demo- aside because giving an account of group moral agency cratic state. https://doi.org/10.1093/phe/phac008 Advance Access publication on 9 April 2022 V C The Author(s) 2022. Published by Oxford University Press. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. 24 MACKAY Defined as a branch of the government, the discussion individuals in society, and not an endorsement of those of public health in my paper excludes some of the exam- practices. This should give us pause and asks public ples that Nihl en Fahlquist includes at the end of her health to reflect upon the use of its power to shape the commentary, such as the physician talking with a patient social context. about weight loss. Ordinary clinical encounters, charac- That said, thinking of public health as a collective terized by a physician or treatment team aiming to bene- moral agent is only a model, a conceptual tool. As fit an individual patient, do not count as public health Midgley (1992: 147) says, ‘a model is only a model ...’; (Wilson, 2021: 10). It is possible that the physician’s we ‘need to keep correcting one model philosophically conversation could be in line with an overarching against another’ for a concept of social life to begin to Public Health Agency endeavour to decrease obesity take shape. Public health ethics will surely need to keep rates, but as a general practitioner, the doctor may not the individual agent in view, alongside public health be specifically affiliated with a public health agency nor agencies conceptualized as collective agents, to form acting in a public health capacity. So, physician–patient the most robust picture of public health activity in a encounters can sometimes be characterized as contribu- society. ting to public health without being public health actions. Turning to the second commentary, Karen Meagher Certainly, the physician–patient relationship is focussed rightly highlights a slippage in my paper between the on the health of the individual patient, and not on the referent of virtue being public health structures (e.g. whole of the public. compassionate policies), and the referent of virtue being Even defined this way, though, the question remains: a social attribute (e.g. policies which cultivate compas- is a Public Health Agency, as a branch of a government, a sionate societies). These are connected and it seems to sum of the individuals who make it up and carry out its me that virtuous policies will contribute to creating vir- initiatives or is it primarily a collective? If a group has tuous societies. However, I acknowledge that I should moral agency, what does this mean? have kept the distinction between these clearer, not least I have posited that public health so defined can be of all because how a policy can be virtuous and how it conceptualized as a collective with moral agency, and could then foster social virtue are each complex ques- again in this response, I cannot fully explore this idea. tions to explore. However, Nihl en Fahlquist is mainly worried that if we What I’d like to address in this response is something look at public health as primarily a collective with moral that Meagher presses me on and which I am also keen to agency, then we will imagine that practices and social better understand. This is the nature of collective virtues, structures exist without individuals (6). This is a prob- specific to public health. A preliminary question lem because public health initiatives can be harmful to Meagher asks is why it might be a distinctive goal of individuals, as a variety of historically recent and distant public health to structure societal virtues, such as com- examples demonstrate. I would emphasize that Nihl en passion. She remarks, ‘it is unclear to me why public Fahlquist and I are both concerned about the power that health institutions should seek to create inter-group public health holds, and my account does not endorse compassion any more than any other public or civic in- the action public health undertakes just by virtue of con- stitution’ (4). Then there is a further set of questions ceiving public health as a collective agent. around how we should conceptualize virtues as features My response to this worry, then, is that the analysis of of collective practices or social structures. public health as a group moral agent is not an endorse- My initial response to Meagher’s first question is that ment of everything it does; in fact, it helps us to locate public health may not be solely responsible for structur- and diagnose systemic harms that can arise within un- ing virtue in a society. It is likely that, as Meagher sug- examined public health practices. Viewing public health gests, public health shares this responsibility with other agencies as moral agents gives us an additional tool for civic organizations or agencies. However, and import- analysing public health practices and initiatives, and antly, public health as I’ve defined it in the paper has explaining some of the ways in which public health unique abilities to support or undermine virtues insofar gets things wrong. My discussion of stigma and the abil- as public health has some powers that are not shared by ity of public health agencies to undermine inter-group other civic organizations or governmental branches: e.g. relations is an example of how considering virtue at this the police powers widely exercised during the corona- level can add to the critical power of public health ethics. virus disease 2019 (CoVid-19) pandemic. While Daniel Daly describes, and I reiterate, that prac- Examples of the ways in which exercising these powers tices can appear as objective reality, that is an explanation undermine inter-group relations abound. In one ex- of the kind of power that practices come to hold over the ample from Australia, in July 2021, New South Wales RESPONSE 25 Health (the state department responsible for public a general feeling of goodwill and a tendency towards health) placed strict restrictions on movement for peo- loose cooperation with others in your society, even if ple living within three metro-Sydney local government they are unknown to you on a personal level. There areas (LGAs) in response to there being 111 local cases of may be some shared traits between civic friendship and CoVid-19 (Razik, 2021). Residents of Canterbury- friendship, including a tendency to show partiality to- Bankstown, Liverpool and Fairfield were banned from wards some people over others; a sense of goodwill to- leaving their LGAs unless they were health or emergency wards particular others; and some level of desire for the services workers. The mayors of these areas expressed other to do well. Different traits between civic friendship frustration and feelings of exclusion and hurt on behalf and friendship might include interpersonal distance ra- of their communities. The restrictions placed on these ther than intimacy; loose connections between my doing LGAs, while others continued to enjoy relative freedom, well and your doing well; and loose connections between increased distrust of public health (for seeming to be ill- my character and yours. founded or arbitrary) and undermined feelings of It also seems like a collective virtue of justice would be cooperation and solidarity. Outside the LGAs, the meas- different from an individual virtue of justice (which ures undermined compassion for residents of these three Aristotle was a bit vague on himself). While many virtues areas by blaming them for an outbreak, and singling seem most at home in the individual character, justice them out as problematic and in need of a different set seems more naturally to fit at the collective level than the of restrictions from everyone else. individual, and I am eager to work out what a fully In exercising some powers, then, it seems clear that conceived collective virtue of justice would look like. public health agencies can damage or undermine social These are not my fully formed views on the question, virtues like compassion, friendship or justice. As such, but suggestions about how collective-level virtues might we should hold public health accountable for this. In have some shared qualities as well as differences when turn, public health should avoid having this effect as compared to the individual-level virtues with which we much as possible, and actively strive to foster virtues are familiar. through its policies and practices. The bottom line To tie this to Meagher’s first question, too, while pub- here is that public health may not be the only govern- lic health may share responsibility for creating the struc- mental agency with a role in fostering virtue in a society, tures of justice in a society with other organizations or but it does have unique powers that can be used to branches of government (meaning it might not be a dis- undermine or uphold structures of virtue. tinctive goal of public health against other branches), There is a related and difficult question Meagher asks, public health has unique powers to contribute to or which has to do with establishing a collective account of undermine social justice. Additionally, if it is not a dis- virtues. She asks, for example, ‘when we say that we de- tinctive goal of public health over other organizations or sire collective trust in public health, do we mean that branches, justice (often conceptualized as equity among public health institutions can be trustworthy in the practitioners) is at least a very important or even central same way as individuals? Or do we mean the kind of goal for public health. trust we need is the same as the figurative use of the To conclude, I wish to express again my gratitude for expression, as in “I trust that the sun will rise tomorrow” the time and effort that Jessica Nihl en Fahlquist and (i.e., I believe I can count on things to be the same)? Or Karen Meagher put into crafting their helpful, insightful do we mean that organizations are trustworthy in an and challenging commentaries. They have given me a lot entirely third way, distinct to institutions (5)?’. to think about, and I hope to continue this dialogue with These are important questions to which I have not yet them, and others, on the topic of public health virtue found answers. I have a hypothesis that there is some- ethics. As is clear from this symposium, there is much thing different about collective-level virtues when com- work to do in this area. pared to individual-level virtues, but developing an account of this is part of my ongoing project. As an ex- ample, I think that the virtue of friendship fully con- Acknowledgements ceived at the collective level (what I think of as ‘civic friendship’) might look different from the individual I would like to express my deep gratitude to Jessica virtue of friendship in some significant ways, but also Nihl en Fahlquist and Karen Meagher for providing share some characteristics. such rich and stimulating commentaries on my paper. To wit, civic friendship might be vaguer and more I am grateful for the time and effort that they have taken diffuse than friendship (the individual virtue), involving in considering the ideas and providing critiques. I would 26 MACKAY also like to thank the editors of Public Health Ethics for Verweij, M. (eds), Ethics, Prevention, and Public facilitating this symposium. Health. Oxford: Oxford University Press, pp. 13–29. Midgley, M. (1992). Philosophical Plumbing. Royal Institute of Philosophy Supplements, 33, 139–151. Razik, N. (2021). Southwest Sydney mayors say new Conflict of Interest COVID-19 restrictions segregates community from rest None declared. of Greater Sydney. SBS News,17 July, available from: https://www.sbs.com.au/news/article/southwest-sydney- mayors-say-new-covid-19-restrictions-segregates-com References munity-from-rest-of-greater-sydney/mobc42j1g Collins, S. (2019). Group Duties. Oxford: Oxford [accessed 5 April 2022]. University Press. Wilson, J. (2021). Philosophy for Public Health & Public Dawson, A. and Verweij, M. (2007). The Meaning of Policy: Beyond the Neglectful State. Oxford: Oxford University Press. ‘Public’ in ‘Public Health’. In Dawson, A. and
Public Health Ethics – Oxford University Press
Published: Apr 9, 2022
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