Stephen John
I am a University Senior Lecturer in the Philosophy of Public Health at the Department of History and Philosophy of Science, University of Cambridge, and Director of Studies in Philosophy at Pembroke College.
My key philosophical interest is in understanding how the fundamental philosophical problem of the relationship between the ethical and the epistemological is, might and should be resolved in practical contexts.
My research so far has clustered around four concepts which are central to policy-making, and which raise both epistemic and ethical puzzles: chance, certainty, categorisation and communication. To address these topics, I draw on a variety of philosophical sub-disciplines, including philosophy of science, political philosophy, applied ethics and social epistemology. I also engage with debates in public health and environmental policy over such topics as the prevention paradox, the precautionary principle, prenatal screening, alcohol policy, vaccination ethics, and climate change.
I am currently engaged in three, inter-locking projects: on overdiagnosis and non-maleficence; on the value of "artifical ignorance"; and on misleading uses of statistics.
In the near future, I hope to turn my attention to a fifth concept, causation, and, in particular, its relationship to the measurement and moral significance of health inequalities.
Address: Department of History and Philosophy of Science
Free School Lane
Cambridge
My key philosophical interest is in understanding how the fundamental philosophical problem of the relationship between the ethical and the epistemological is, might and should be resolved in practical contexts.
My research so far has clustered around four concepts which are central to policy-making, and which raise both epistemic and ethical puzzles: chance, certainty, categorisation and communication. To address these topics, I draw on a variety of philosophical sub-disciplines, including philosophy of science, political philosophy, applied ethics and social epistemology. I also engage with debates in public health and environmental policy over such topics as the prevention paradox, the precautionary principle, prenatal screening, alcohol policy, vaccination ethics, and climate change.
I am currently engaged in three, inter-locking projects: on overdiagnosis and non-maleficence; on the value of "artifical ignorance"; and on misleading uses of statistics.
In the near future, I hope to turn my attention to a fifth concept, causation, and, in particular, its relationship to the measurement and moral significance of health inequalities.
Address: Department of History and Philosophy of Science
Free School Lane
Cambridge
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Should we vaccinate 12-15 year olds against Covid-19? The U.K.'s Joint Committee on Vaccination and Immunisation said not, but the U.K. government adopted this policy anyway. This gap between experts and policy-makers has created controversy. 1 Such controversies will become more heated given proposals to lower the age range for vaccination policies further. 2 This paper uses this case to explore some of the ethical issues around offering Covid-19 vaccines to children. My main conclusion is rather paradoxical: the younger we go, the stronger the grounds for justified parental hesitancy, and, as such, the stronger the arguments for enforcing vaccination.
Drawing on literature on values in science and a case-study of UK cancer policy, this paper argues for a novel account of the demarcation project in terms of trustworthiness.
During the COVID-19 pandemic, there was disagreement over whether or not the science supported facemask mandates. This paper interrogates debates over this question, paying particular attention to an ambiguity between two scientific virtues: epistemic caution and epistemic responsiveness. I suggest that there is an argument from each virtue to reasons to trust scientists' claims in policy debate. However, as the case of facemask debates illustrates, it is not clear that scientists can possess both virtues simultaneously: the two virtues are in tension. After showing how this general framework can help us better understand debate, I turn to consider some possible ways of resolving this tension, arguing
Screening for asymptomatic disease is a routine aspect of contemporary public health practice. However, it is also controversial, because it leads to overdiagnosis and overtreatment, with many arguing that programmes are "ineffective", i.e. the "costs" outweigh the "benefits". This paper explores a more fundamental objection to screening programmes: that, even if they are effective, they are ethically impermissible because they breach the principle of non-maleficence. In so doing, it suggests a new approach to the ethics of risk, justifying a concern with how policies affect individuals' absolute ex-ante prospects. Part 1 sets up the tension between screening and non-maleficence. Part 2 introduces and motivates a novel interpretation of the non-maleficence principle, "ex-ante Do No Harm", which resolves this tension. Part 3 defends and clarifies this principle by discussing its relationship to the ex-ante Pareto principle. Part 4 discusses the worry that risk estimates are too "subjective".
https://kiej.georgetown.edu/ethics-of-lockdown-special-issue/
Are lockdown measures ethically justified? This paper outlines some of the key issues relevant to answering that question, paying particular attention to how decisions are framed. Section 1 argues that ethical reasoning about lockdown ought to be guided by a distinction between prudential and ethical reasons, grounded in a concern to respect the separateness of persons, but also that—as public health messaging implies—it can be unclear whether measures are in individuals’ prudential interests or not. Section 2 suggests that a similar set of problems affect attempts to adopt alternative cost-benefit-analysis frameworks for assessing lockdown. Section 3 suggests an answer to these shared problems: we need a process for determining when wellbeing claims and systems of categorization are ethically apt. Section 4 argues that settling the question of aptness is our key ethical task in assessing lockdown.
In this paper I ask two questions prompted by the phenomenon of " politically patterned " climate change denial. First, can an individual's political commitments provide her with good reasons not to defer to cognitive experts' testimony? Building on work in philosophy of science on inductive risk, I argue they can. Second, can an individual's political commitments provide her with good reasons not to defer to the Intergovernmental Panel on Climate Change's testimony? I argue that they cannot (at least, in the way identified in the first part of the paper), because of the high epistemic standards which govern that body's assertions. The conclusion discusses the theoretical and practical implications of my arguments.
Should we vaccinate 12-15 year olds against Covid-19? The U.K.'s Joint Committee on Vaccination and Immunisation said not, but the U.K. government adopted this policy anyway. This gap between experts and policy-makers has created controversy. 1 Such controversies will become more heated given proposals to lower the age range for vaccination policies further. 2 This paper uses this case to explore some of the ethical issues around offering Covid-19 vaccines to children. My main conclusion is rather paradoxical: the younger we go, the stronger the grounds for justified parental hesitancy, and, as such, the stronger the arguments for enforcing vaccination.
Drawing on literature on values in science and a case-study of UK cancer policy, this paper argues for a novel account of the demarcation project in terms of trustworthiness.
During the COVID-19 pandemic, there was disagreement over whether or not the science supported facemask mandates. This paper interrogates debates over this question, paying particular attention to an ambiguity between two scientific virtues: epistemic caution and epistemic responsiveness. I suggest that there is an argument from each virtue to reasons to trust scientists' claims in policy debate. However, as the case of facemask debates illustrates, it is not clear that scientists can possess both virtues simultaneously: the two virtues are in tension. After showing how this general framework can help us better understand debate, I turn to consider some possible ways of resolving this tension, arguing
Screening for asymptomatic disease is a routine aspect of contemporary public health practice. However, it is also controversial, because it leads to overdiagnosis and overtreatment, with many arguing that programmes are "ineffective", i.e. the "costs" outweigh the "benefits". This paper explores a more fundamental objection to screening programmes: that, even if they are effective, they are ethically impermissible because they breach the principle of non-maleficence. In so doing, it suggests a new approach to the ethics of risk, justifying a concern with how policies affect individuals' absolute ex-ante prospects. Part 1 sets up the tension between screening and non-maleficence. Part 2 introduces and motivates a novel interpretation of the non-maleficence principle, "ex-ante Do No Harm", which resolves this tension. Part 3 defends and clarifies this principle by discussing its relationship to the ex-ante Pareto principle. Part 4 discusses the worry that risk estimates are too "subjective".
https://kiej.georgetown.edu/ethics-of-lockdown-special-issue/
Are lockdown measures ethically justified? This paper outlines some of the key issues relevant to answering that question, paying particular attention to how decisions are framed. Section 1 argues that ethical reasoning about lockdown ought to be guided by a distinction between prudential and ethical reasons, grounded in a concern to respect the separateness of persons, but also that—as public health messaging implies—it can be unclear whether measures are in individuals’ prudential interests or not. Section 2 suggests that a similar set of problems affect attempts to adopt alternative cost-benefit-analysis frameworks for assessing lockdown. Section 3 suggests an answer to these shared problems: we need a process for determining when wellbeing claims and systems of categorization are ethically apt. Section 4 argues that settling the question of aptness is our key ethical task in assessing lockdown.
In this paper I ask two questions prompted by the phenomenon of " politically patterned " climate change denial. First, can an individual's political commitments provide her with good reasons not to defer to cognitive experts' testimony? Building on work in philosophy of science on inductive risk, I argue they can. Second, can an individual's political commitments provide her with good reasons not to defer to the Intergovernmental Panel on Climate Change's testimony? I argue that they cannot (at least, in the way identified in the first part of the paper), because of the high epistemic standards which govern that body's assertions. The conclusion discusses the theoretical and practical implications of my arguments.
Epidemiology studies the distribution and determinants of health outcomes within populations. A wide variety of political philosophies agree that policy-makers should care about the distribution and determinants of health. Hence, much epidemiological research is, could be, or should be policy-relevant. However, translating epidemiological research into policy also requires ethical or political deliberation; for example, even if we established with full certainty that eating processed meat causes cancer, it doesn't follow that the State must ban the sale of processed meat, if doing so would involve a curtailment of individual liberty. Many of the ethical issues which arise at the interface between epidemiology and policy, such as the proper balance between the public good and individual liberty, are familiar from broader ethical and political debate. 1 2 3 This chapter outlines two less familiar issues, both falling under the broad topic of "the ethics of risk": problems of chance and problems of certainty. Problems of chance concern the ways in which risk factor epidemiology complicates the task of balancing between individual interests and the collective good. For example, a 2012 study of the UK's breast cancer screening program concluded that the population benefits-1,300 deaths from breast cancer prevented each year-outweighed the population costs of overdiagnosis and overtreatment. 4 Nonetheless, for each individual, the probability that her life will be saved by attending screening is very low-about 1-in-180-and must be weighed against a chance of medically unnecessary treatment (as well as the less concrete costs of being "medicalised"). It seems possible, then, that aggregate population health would be improved if each invitee attended screening, but, also, that each individual might reasonably