Journal of Bioethical Inquiry, Volume 10, Number 2 (June 2013)
Guest Editor: Rob Irvine
Michael A. Ashby and Leigh E. Rich
Letters to the Editor
Hamid Reza Salehi
Bernadette Richards and John Coggon
Private Governance, Public Purpose? Assessing Transparency and Accountability in Self-Regulation of Food Advertising to Children
Reducing non-core food advertising to children is an important priority in strategies to address childhood obesity. Public health researchers argue for government intervention on the basis that food industry self-regulation is ineffective; however, the industry contends that the existing voluntary scheme adequately addresses community concerns. This paper examines the operation of two self-regulatory initiatives governing food advertising to children in Australia, in order to determine whether these regulatory processes foster transparent and accountable self-regulation. The paper concludes that while both codes appear to establish transparency and accountability mechanisms, they do not provide for meaningful stakeholder participation in the self-regulatory scheme. Accordingly, food industry self-regulation is unlikely to reflect public health concerns or to be perceived as a legitimate form of governance by external stakeholders. If industry regulation is to remain a feasible alternative to statutory regulation, there is a strong argument for strengthening government oversight and implementing a co-regulatory scheme.
Christine Parker, Carly Brunswick, and Jane Kotey
This paper investigates what “free-range” eggs are available for sale in supermarkets in Australia, what “free-range” means on product labelling, and what alternative “free-range” offers to cage production. The paper concludes that most of the “free-range” eggs currently available in supermarkets do not address animal welfare, environmental sustainability, and public health concerns but, rather, seek to drive down consumer expectations of what these issues mean by balancing them against commercial interests. This suits both supermarkets and egg producers because it does not challenge dominant industrial-scale egg production and the profits associated with it. A serious approach to free-range would confront these arrangements, and this means it may be impossible to truthfully label many of the “free-range” eggs currently available in the dominant supermarkets as free-range.
The vegan project is defined as the project that strives for radical legal reform to pass laws that would reserve the consumption of animal products to a very narrow range of situations, resulting in vegan diets being the default diets for the majority of human beings. Two objections that have been raised against such a project are described. The first is that such a project would jeopardise the nutritional adequacy of human diets. The second is that it would alienate human beings from nature. It is argued that neither undermines the vegan project.
In recent years we have seen the emergence of “personalised medicine.” This development can be seen as the logical product of reductionism in medical science in which disease is increasingly understood in molecular terms. Personalised medicine has flourished as a consequence of the application of neoliberal principles to health care, whereby a commercial and social need for personalised medicine has been created. More specifically, personalised medicine benefits from the ongoing commercialisation of the body and of genetic knowledge, the idea that health is defined by genetics, and the emphasis the state places on individual citizens as being “responsible for” their own health. In this paper I critique the emergence of personalised medicine by examining the ways in which it has already impacted upon health and health care delivery.
Wendy Lipworth, Miles Little, Pippa Markham, Jill Gordon, and Ian Kerridge
While doctors generally enjoy considerable status, some believe that this is increasingly threatened by consumerism, managerialism, and competition from other health professions. Research into doctors’ perceptions of the changes occurring in medicine has provided some insights into how they perceive and respond to these changes but has generally failed to distinguish clearly between concerns about “status,” related to the entitlements associated with one’s position in a social hierarchy, and concerns about “respect,” related to being held in high regard for one’s moral qualities. In this article we explore doctors’ perceptions of the degree to which they are respected and their explanations for, and responses to, instances of perceived lack of respect. We conclude that doctors’ concerns about loss of respect need to be clearly distinguished from concerns about loss of status and that medical students need to be prepared for a changing social field in which others’ respect cannot be taken for granted.
Wendy A. Rogers and Jane Johnson
In this paper we argue that surgeons face a particular kind of within-role conflict of interests, related to innovation. Within-role conflicts occur when the conflicting interests are both legitimate goals of professional activity. Innovation is an integral part of surgical practice but can create within-role conflicts of interest when innovation compromises patient care in various ways, such as by extending indications for innovative procedures or by failures of informed consent. The standard remedies for conflicts of interest are transparency and recusal, which are unlikely to address this conflict, in part because of unconscious bias. Alternative systemic measures may be more effective, but these require changes in the culture of surgery and accurate identification of surgical innovation.
Stefan M. van Geelen, Ineke L. E. Bolt, Olga H. van der Baan-Slootweg, and Marieke J. H. van Summeren
Despite the reported limited success of conventional treatments and growing evidence of the effectiveness of adult bariatric surgery, weight loss operations for (morbidly) obese children and adolescents are still considered to be controversial by health care professionals and lay people alike. This paper describes an explorative, qualitative study involving obesity specialists, morbidly obese adolescents, and parents and identifies attitudes and normative beliefs regarding pediatric bariatric surgery. Views on the etiology of obesity—whether it should be considered primarily a medical condition or more a psychosocial problem—seem to affect the specialists’ normative opinions concerning the acceptability of bariatric procedures as a treatment option, the parents’ feelings regarding both being able to influence their child’s health and their child being able to control their own condition, and the adolescents’ sense of competence and motivation for treatment. Moreover, parents and adolescents who saw obesity as something that they could influence themselves were more in favor of non-surgical treatment and vice versa. Conflicting attitudes and normative views—e.g., with regard to concepts of disease, personal influence on health, motivation, and the possibility of a careful informed consent procedure—play an important role in the acceptability of bariatric surgery for childhood obesity.
Some have challenged Thomson’s case of the famous unconscious violinist (UV) by arguing that in cases of consensual sex a woman is partially morally responsible for the existence of a needy fetus; since she is partially responsible she ought to assist the fetus, and so abortion is morally wrong. Call this the Responsibility Objection (RO) to UV. In this paper, I briefly criticize one of the most widely discussed objections to RO and then suggest a new way to challenge RO. In so doing, I investigate the plausibility of the moral principle that appears to be driving RO: If a woman is partially morally responsible for the existence of a needy fetus, she has a moral obligation to assist the fetus. I argue that this principle is false. I suggest modified versions of this principle but argue that, even on the most plausible version, RO does not persuade.
Ola Didrik Saugstad