Mutual Moral Obligations in the Prevention of Infectious Diseases

  • Jeroen Luyten
Part of the Library of Ethics and Applied Philosophy book series (LOET, volume 30)


Not so long ago health policy was about little more than the provision of medical care. The availability of treatment is important for those in need of cure, but by now it is a well-shown fact that health is generally determined to a much greater extent by other factors. Genetic constitution, lifestyle choices and socio-economic environment largely explain why some of us become ill or die earlier than others who remain healthy (Mackenbach 1996; McKeown 1976; Wilkinson and Marmot 2003). While some of these factors fall under the control of an individual, the majority does not. Research increasingly indicates how remarkably sensitive our health seems to be to what has become known as the ‘social determinants of health’. These factors generally fall beyond the control of an individual, but can nonetheless be influenced on a population level. This causes a shift in the focus of health policy from the classic provision of health care to policies specifically designed to influence the causal factors of ill-health in different non-medical fields. The flipside of that evolution is a significant increase of the state’s influence in the sphere of individual lives. A pertinent question remains the one that asks for the legitimate role of governments in modifying, discouraging or prohibiting behaviors that lead to ill-health. To what extent can and should we hold public policy responsible for us leading a healthy life? Most scholars will argue that governments indeed have a role to play, but that the limits will be reached when public health measures would imply large sacrifices of individual liberty.


Moral Obligation Moral Duty Precautionary Measure Private Sphere Public Health Emergency 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Arias, C.A., and B.E. Murray. 2009. Antibiotic-resistant bugs in the 21st century – A clinical superchallenge. The New England Journal of Medicine 360: 439–443.CrossRefGoogle Scholar
  2. Balog, J.E. 2009. The moral justification for a compulsory human papillomavirus vaccination program. American Journal of Public Health 99: 616–622.CrossRefGoogle Scholar
  3. BBC. 2003. HIV man guilty of infecting lovers (Online). Available: Accessed 07 June 2011.
  4. BBC. 2010. German girl band star charged in HIV case (Online). Available: Accessed 07 June 2011.
  5. Belgisch staatsblad. 2005. Koninklijk Besluit Betreffende Levensmiddelenhygiëne (Online). Available: Accessed 07 June 2011.
  6. Beran, G.W. 2008. Disease and destiny-mystery and mastery. Preventive Veterinary Medicine 86: 198–207.CrossRefGoogle Scholar
  7. Bryce, J., C. Boschi-Pinto, K. Shibuya, and R.E. Black. 2005. WHO estimates of the causes of death in children. The Lancet 365: 1147–1152.CrossRefGoogle Scholar
  8. Carlet, J., P. Collignon, D. Goldmann, H. Goossens, I.C. Gyssens, S. Harbarth, V. Jarlier, S.B. Levy, B. N’Doye, D. Pittet, R. Richtmann, W.H. Seto, J.W. Van der Meer, and A. Voss. 2011. Society’s failure to protect a precious resource: Antibiotics. The Lancet 378(9788): 369–371.CrossRefGoogle Scholar
  9. CDC. 2011a. Effective TB interviewing for contact investigation: Self-study modules (Online). Available: Accessed 16 Aug 2011.
  10. CDC. 2011b. How flu spreads (Online). Available: Accessed 15 Aug 2011.
  11. CDC. 2011c. Transmission of measles (Online) Available: Accessed 15 Aug 2011.
  12. Dawson, A. 2007. What are the moral obligations of the traveller in relation to vaccination? Travel Medicine and Infectious Disease 5: 90–96.CrossRefGoogle Scholar
  13. Dowdle, W.R. 1998. The principles of disease elimination and eradication. Bulletin of the World Health Organization 76(suppl. 2): 22–25.Google Scholar
  14. Giles-Vernick, T., and S. Craddock. 2010. Influenza and public health: Learning from past pandemics. London: Earthscan.Google Scholar
  15. Greenough, P. 1995. Intimidation, coercion and resistance in the final stages of the South Asian smallpox eradication campaign 1973–1975. Social Science & Medicine 41: 633–645.CrossRefGoogle Scholar
  16. Harris, J., and S. Holm. 1995. Is there a moral obligation not to infect others? British Medical Journal 311: 1215–1217.CrossRefGoogle Scholar
  17. Henderson, D.A. 1999. The looming threat of bioterrorism. Science 283: 1279–1282.CrossRefGoogle Scholar
  18. Henderson, D.A., L.L. Borio, and J.D. Grabenstein. 2008. Smallpox and vaccinia. In Vaccines, ed. S. Plotkin, P. Offit, and W. Orenstein. Philadelphia: Elsevier.Google Scholar
  19. Hinman, A.R. 2004. Immunization, equity, and human rights. American Journal of Preventive Medicine 26: 84–88.CrossRefGoogle Scholar
  20. Jefferson, T., R. Foxlee, C. Del Mar, L. Dooley, E. Ferroni, B. Hewak, A. Prabhala, S. Nair, and A. Rivetti. 2008. Physical interventions to interrupt or reduce the spread of respiratory viruses: Systematic review. British Medical Journal 336: 77–80.CrossRefGoogle Scholar
  21. Johnson, N.P., and J. Mueller. 2002. Updating the accounts: Global mortality of the 1918–1920 “Spanish” influenza pandemic. Bulletin of the History of Medicine 76: 105–115.CrossRefGoogle Scholar
  22. Jones, K.E., N.G. Patel, M.A. Levy, A. Storeygard, D. Balk, J.L. Gittleman, and P. Daszak. 2008. Global trends in emerging infectious diseases. Nature 451: 990–993.CrossRefGoogle Scholar
  23. Kantak, K.M. 2003. Vaccines against drugs of abuse: A viable treatment option? Drugs 63: 341–352.CrossRefGoogle Scholar
  24. Knobler, S.L., A. Mack, A. Mahmoud, and S.M. Lemon (eds.). 2005. Institutes of medicine: The threat of pandemic influenza: Are we ready? Washington, DC: National Academies Press.Google Scholar
  25. Luyten, J., and P. Beutels. 2009. Costing infectious disease outbreaks for economic evaluation: A review for hepatitis A. PharmacoEconomics 27: 379–389.CrossRefGoogle Scholar
  26. Mackenbach, J.P. 1996. The contribution of medical care to mortality decline: McKeown revisited. Journal of Clinical Epidemiology 49: 1207–1213.CrossRefGoogle Scholar
  27. McKeown, T. 1976. The role of medicine: Dream, mirage, or nemesis? London: Nuffield Provincial Hospitals Trust.Google Scholar
  28. Mitka, M. 2007. Face masks, respirators might help during pandemic flu outbreak. Journal of the American Medical Association 297: 2338.CrossRefGoogle Scholar
  29. Norkin, L.C. 2010. Virology: Molecular biology and pathogenesis. Washington, DC: American Society for Microbiology Press.Google Scholar
  30. Patz, J.A., D. Campbell-Lendrum, T. Holloway, and J.A. Foley. 2005. Impact of regional climate change on human health. Nature 438: 310–317.CrossRefGoogle Scholar
  31. Roberts, L. 2005. Infectious disease. Polio eradication effort adds new weapon to its armory. Science 307: 190.CrossRefGoogle Scholar
  32. Roush, S.W., and T.V. Murphy. 2007. Historical comparisons of morbidity and mortality for vaccine-preventable diseases in the United States. Journal of the American Medical Association 298: 2155–2163.CrossRefGoogle Scholar
  33. Scanlon, T.M. 1998. What we owe to each other. Cambridge: Harvard University Press.Google Scholar
  34. Selgelid, M.J. 2003. Smallpox revisited? The American Journal of Bioethics 3(1): W5–W11.CrossRefGoogle Scholar
  35. Selgelid, M.J. 2004. Bioterrorism and smallpox planning: Information and voluntary vaccination. Journal of Medical Ethics 30: 558–560.CrossRefGoogle Scholar
  36. Selgelid, M.J. 2005. Ethics and infectious disease. Bioethics 19: 272–289.CrossRefGoogle Scholar
  37. Singer, P. 1972. Famine, affluence, and morality. Philosophy & Public Affairs 1: 229–243.Google Scholar
  38. Stafford, N. 2008. Belgian parents are sentenced to prison for not vaccinating children. British Medical Journal 336: 348.CrossRefGoogle Scholar
  39. Standaard, D. 2011. Celstraf voor Opzettelijke Hiv-besmetting (Online). Available: Accessed 31 May 2011.
  40. Strawson, P. 1962. Freedom and resentment. Proceedings of the British Academy 48: 1–25.Google Scholar
  41. Verweij, M. 2005. Obligatory precautions against infection. Bioethics 19: 323–335.CrossRefGoogle Scholar
  42. WHO. 2009a. Fact sheet: Influenza (seasonal) (Online). Available: Accessed 31 May 2011.
  43. WHO. 2009b. Global summary of the AIDS epidemic (Online). Available: Accessed 31 May 2011.
  44. WHO. 2009c. Tuberculosis fact sheet (Online). Available: Accessed 31 May 2011.
  45. WHO. 2011. Fact sheet: The top ten causes of death (Online). Available: Accessed 31 May 2011.
  46. Wilkinson, R., and M. Marmot. 2003. Social determinants of health: The solid facts. Copenhagen: WHO.Google Scholar
  47. Williamson, E.D., A.J. Simpson, and R.W. Titball. 2008. Plague vaccines. In Vaccines, ed. S. Plotkin, P. Offit, and W. Orenstein. Philadelphia: Elsevier.Google Scholar
  48. Woonink, F. 1953. Bezwaren tegen Vaccinaties: Het Perspectief van de Weigeraar. Bithoven: Rijksinstituut voor Volksgezondheid en Milieu.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  1. 1.Centre for Health Economics Research and Modeling Infectious DiseasesUniversity of AntwerpAntwerpBelgium

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