Justice, and health.
People in lower socio-economic classes on average have shorter lives and are less healthy than people in higher socio-economic classes and this raises concerns about justice. Indeed, health policies often aspire to improve the health of worse-off groups, or otherwise reduce (socio-economic) health disparities. But if we are interested in reducing health inequalities for reasons of justice, what indicators of health and/or health-related quality of life should we use? In the Netherlands, the average life-expectancy for people in lowest socio-economic groups is 7 years less than for those in the highest class, but health disparities appear much higher (up to 20 years) if more subjective measures of health or quality of life are included.
The core elements of the philosophical PhD study are (a) to clarify the links between various theories of health and quality of life, and (b) to assess the ethical relevance of concepts and measures of health and quality of life from the perspective of theories of health justice. This work interacts with empirical studies carried out at Amsterdam Medical Centre (Karien Stronks) that aim to clarify how people in different socio-economic classes conceptualise health. The research program will result in proposals how health and quality of life should be conceptualised and measured in policies that aim to reduce health inequalities. The PhD study is carried out by Beatrijs Haverkamp and supervised by Marcel Verweij and Bernice Bovenkerk.
Preventing infections in transfusion blood: An ethical analysis of moral responsibility and fairness in public health
The Philosophy group collaborates with the Netherlands blood services organization, Sanquin, to explore ethical issues in relation to blood safety. Donor blood is screened for infectious agents to protect recipients against harmful infections. However, some screening measures may cost more than 1,000,000 per life year gained. There may be good reasons for aiming at very high safety levels in blood transfusion, but what costs are justified in times where public health care faces clear limits and basic health services are rationed? This question requires a better understanding of the scope of moral responsibility of blood services regarding precautions and prevention of infection via donated blood. This question is the background for several ethical substudies that aim to clarify and critically review the normative assumptions behind and arguments about current blood screening policies. Through review of arguments and concepts, taking into account the specific features of blood donation practice, this study will formulate practical criteria for deciding which tests should be included in blood donor screening. The PhD study is carried out by Koen Kramer and led by philosopher Marcel Verweij and medical microbiologist Hans Zaaijer; it is fully sponsored by Sanquin. Recent results: PhD student Koen Kramer published his first paper in the journal Transfusion. It is a review of blood safety policies and procedures in 5 Western countries, exploring what concerns are driving current policies regarding the prevention of transfusion-transmittable infections. The study focuses on general policies and on the introduction of hepatitis B virus nucleic acid testing and selected measures against variant Creutzfeldt-Jakob disease, West Nile virus, and Q-fever. Analysis of policy documents show how blood services take a variety of ethical, scientific and societal considerations into account, but decision making processes are often not as transparent as one would expect in democratic societies. The paper was picket out by the journal editors for a special commentary. A second paper "Donor blood screening and moral responsibility: How safe should blood be?" was recently accepted in the Journal of Medical Ethics and will be published later in 2016.