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Public Health Ethics, Legitimacy, and the Challenges of Industrial Wind Turbines: The Case of Ontario, Canada

by Martin Shain on behalf of the National Association for Science, Technology & Society

Used with permission from the author

(part 2 — continuing from yesterday)

Overall Benefit (Beneficence)

The argument is that public health is a good by definition, because most people benefit from it in one area or another. This is a net social gain type of argument.

The net gain argument is bolstered in modern economics by statistical models that seek to demonstrate population health benefits on an aggregated basis. These models often embed moral assumptions that are not always apparent under the guise of supposedly objective cost utility analyses. For example, the health of the elderly may be discounted as less valuable than the health of the young: the rights of those with “poor” health habits may be devalued in contrast to those who attend (and can afford to attend) health clubs and gyms and shop at high-end food stores (see, e.g., Brock, 2002; Gafni, 1991; Powers & Faden, 2006). And lurking in the shadows of cost utility analyses in the public health arena is the ever pres- ent specter of eugenics.

As Faden and Shebaya (2010) state,

There is the risk that the findings emerging from these formal analyses will have determinative influence in policy circles. This risk is augmented by the increasing interest in attempting to empiricize moral considerations by measuring and aggregating the value preferences of the public about moral tradeoffs such as prioritizing by age or life-saving potential (Baker et al., 2008; Menzel et al., 1999; Nord, 1999). These aggre- gated preferences are then transformed into weights intended to incorporate moral values directly into the structure of the formal methodology, a move that is open to criticism on methodological as well as substantive grounds. (p. 17)

Applied to IWTs one can appreciate that green ideology could be “empiricized” to the point at which it trumps all other values in the development of wind energy policy.

Collective Efficiency

The argument is that in a complex society threatened by so many health risks from so many sources it is efficient for a central agency (public health) to oversee and regulate these risks because agencies organized according to specific issues could not hope to achieve the same level of proficiency.

While there is an intuitive appeal to this sort of argument, it fails to acknowledge the reality that public health concerns are often embedded in policies and practices that fall outside the sphere of public health agencies. IWTs are a leading example of this type of governmental dissonance. As noted above, the regulation of IWTs does not at present fall within an official public health remit in spite of the numerous and compelling claims advanced by various researchers in this issue.

Harm Prevention

The argument is that restriction or curtailment of the rights of a few can be justified only by prevention of harm to the many (Mill, 1869/1998).

This argument has been used in various public health and safety contexts but usually the contrast is between incursions on individual liberty (as in the case of compulsory seat belt or helmet use and no smoking in public places rules) and collec- tive health benefits. In the case of IWTs, the contrast as noted already is between health benefits to the many versus health risks to a few, a situation to which the Harm Principle may not be best suited, although it must be said that advocates’ claims for IWTs go beyond collective health benefits to embrace other putative social goods. These include increased freedom from reliance on nonrenewable energy sources. Insofar then as the contrast is between sacrificing the health of a few in the service of an anticipated bright energy future for the many, perhaps the Mills formulation is more useful. In this context, the prevention of harm to the many becomes a projected scenario in which the majority is “not harmed” by the perpetual threat that oil, gas, and even coal may run out or become inaccessible to us. Certainly, the trade-off is between a clear and evident loss to a few and the unknown, even vague probability of benefit to the many.

Paternalism

The argument is that government can interfere with the liberty or other rights of a few because it is ultimately in their best interests and certainly in the interests of the majority.

In the case of IWTs, the strong paternalistic case is made implicitly and sometimes explicitly that opponents are stupid, stubborn, or both because they do not know what is best for them in the long run. Their stupidity therefore disqualifies them from any further participation in the determination of their own fate.

A softer “libertarian” version of paternalism requires that until people are led to understand the benefits of the measures to which they are about to be unwillingly exposed they should not be subjected to them. Some argue that this is not paternalism at all but rather a form of participatory governance consistent with grassroots democracy. In any event, in this version people who did not accept that IWTs were likely to be a net benefit to them would not be obliged to consent to have them installed within a range accepted by the more prudential scientific community as likely to cause harm to their health.

Fairness

The argument is that in a democratic society we expect a relatively even social distribution of burdens when these are imposed and directed by government. Unequal distribution is unfair and therefore requires specific justification. In the case of IWTs, this justification might take the path of suggesting that all of us ultimately benefit from green energy in reduced pollution and eventually in freedom from reliance on nonrenewable fossil fuel sources. Consequently, harm to a few is justified by good for the many, which may even include the few who suffer in the short run but reap benefits in the end.

A particular problem arises in this context involving the disproportionate impact of certain public health measures on already disadvantaged groups. In the case of IWTs, this refers to those home and business owners who are economically disadvantaged to the extent that they do not have the option to sell and move from the location in which they are being harmed or expect to be harmed by the careless introduction of wind energy generators.

Again as Faden and Shebaya (2010) state,

There is broad agreement that a commitment to improving the health of those who are systematically disadvantaged is as constitutive of public health as is the commitment to promote health generally (Institute of Medicine, Committee for the Study of the Future of Public Health, 1988; Nuffield Council on Bioethics, 2007; Powers & Faden, 2006, Thomas, Sage, Dillenberg, & Guillory, 2002). (p. 14)

Faden and Shebaya (2010) continue,

When the burdens of a policy fall heavily on those who are already disadvantaged, the justificatory hurdle is particularly high. This concern is at the heart of many environmental justice controversies such as the locating of hazardous waste facilities and hazard- ous industries in low income communities and coun- tries. (p. 16)

In other words, it is contradictory to the essence of public health ethics, at least insofar as it is grounded in fairness, to further disadvantage the already disadvantaged.

As we explore the further reaches of legitimacy in the next section of this article, fairness will be seen to take on an even more important role.

(part 3 tomorrow)

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  1. Public Health Ethics, Legitimacy, and the Challenges of Industrial Wind Turbines: The Case of Ontario, Canada | Quixotes Last Stand - July 16, 2012

    […] (Part 2 – Public Health Ethics, Legitimacy, and the Challenges of Industrial Wind Turbines: The Case of Ontari…) […]

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