Public Health Ethics Advance Access originally published online on May 27, 2009
Public Health Ethics 2009 2(2):158-170; doi:10.1093/phe/php011
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Public Health and the Rights of States
Harvard Program in Ethics and Health
* Corresponding author: The Harvard University Program in Ethics and Health, 651 Huntington Avenue, 6th floor c/o HSPH, François Xavier Bagnoud Building, Boston, MA 02115, USA. Tel.: +1 617 4327244; Email: andras_miklos{at}hms.harvard.edu
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Abstract |
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When exercising their public health powers, states claim various rights against their subjects and aliens. The paper considers whether public health considerations can help justify some of these rights, and explores some constraints on the justificatory force of public health considerations. I outline two arguments about the moral grounds for states’ rights with regard to public health. The principle of fairness emphasizes that those who benefit from public health measures ought to contribute their fair share in upholding them. Alternatively, states’ rights might be justified by a natural duty of justice to uphold and not to obstruct institutions implementing public health policies. I indicate some reasons for preferring the latter justification. I further argue that the assignment of some rights to states via public health-based justification is undermined on several counts. Domestic political institutions cannot effectively perform some of their functions in protecting public health. Furthermore, transborder public health threats pose collective action problems at the global level. Finally, concerns about human rights work against the assignment of some rights to states. I conclude by arguing that these concerns call for global coordination, and that some rights claimed by states ought instead to be assigned to global institutions.