Snakes and ladders: state interventions and the place of liberty in public health policy.

In this paper I outline and explore some problems in the way that the Nuffield Council of Bioethics' report Public Health: Ethical Issues (2007) presents its 'Intervention Ladder'. They see the metaphor of a ladder both as capturing key normative priorities and as making a real and important contribution to ethical policymaking in public health. In this paper I argue that the intervention ladder is not a useful model for thinking about policy decisions, that it is likely to produce poor decisions and that it is incompatible with the report's stated approach to relevant public health policy values.

Ebola: what it tells us about medical ethics.

Good medical ethics needs to look more to the resources of public health ethics and use more societal, population or community values and perspectives, rather than defaulting to the individualistic values that currently dominate discussion. In this paper I argue that we can use the recent response to Ebola as an example of a major failure of the global community in three ways. First, the focus has been on the treatment of individuals rather than seeing that the priority ought to be public health measures. Second, the advisory committee on experimental interventions set up by the WHO has focused on ethical issues related to individuals and their guidance has been unclear. Third, the Ebola issue can be seen as a symptom of a massive failure of the global community to take sufficient notice of global injustice.

An ethical argument in favour of routine hepatitis B vaccination in very low-incidence countries.

Hepatitis B is a potentially life-threatening viral infection that can be prevented through safe vaccination. This article argues that, firstly, there are important reasons to question the common policy of focusing on at-risk populations, and secondly, that there are positive reasons for very low-incidence countries such as the UK to consider implementing a programme of routine vaccination for hepatitis B. These conclusions can be supported by the strong ethical presumption that where a potentially devastating disease is easily preventable, those at potential risk should be protected. Even in very low-incidence countries such as the UK a policy based upon routine vaccination for hepatitis B may be an efficient and ethical way to reduce the burden of this disease.

Contesting the science/ethics distinction in the review of clinical research.

Recent policy in relation to clinical research proposals in the UK has distinguished between two types of review: scientific and ethical. This distinction has been formally enshrined in the recent changes to research ethics committee (REC) structure and operating procedures, introduced as the UK response to the EU Directive on clinical trials. Recent reviews and recommendations have confirmed the place of the distinction and the separate review processes. However, serious reservations can be mounted about the science/ethics distinction and the policy of separate review that has been built upon it. We argue here that, first, the science/ethics distinction is incoherent, and, second, that RECs should not only be permitted to consider a study's science, but that they have an obligation do so.